Right Hemidiaphragmatic Mobility: Assessment with US Measurement of Craniocaudal Displacement of Left Branches of Portal Vein

Toledo, Nair S. G.; Kodaira, Sérgio Keidi; Massarollo, Paulo Celso Bosco; Pereira, Osvaldo José Ribeiro; Mies, Sérgio

doi:10.1148/radiol.2282011554

Cited by 52 publications

(69 citation statements)

References 31 publications

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“…Para medida da mobilidade diafragmática as radiografias foram sobrepostas, alinhando-se os processos espinhosos das vértebras e, por meio de uma régua milimetrada, foi medida a distância do ponto mais alto da hemicúpula diafragmática (direita e esquerda) da radiografia em expiração máxima, traçando-se a partir daí uma linha, até sua intercessão com a hemicúpula diafragmática da radiografia em inspiração máxima. A distância encontrada foi registrada em centímetros (cm) 18,19 .…”

Section: Avaliação Pré -Operatóriaunclassified

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

et al. 2009

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RESUMO: O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês) e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por videolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m 2 , submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias). Foram divididas em dois grupos, GI -grupo inspirômetro (n=13) e GE, grupo EPAP (n=15). A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós-operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório. DESCRITORES: Cirurgia bariátrica; Exercícios respiratórios; Fisioterapia (Especialidade); Obesidade ABSTRACT: The aim of this study was to compare the effect of expiratory positive airway pressure (EPAP) and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m 2 , undergoing laparoscopic gastric bypass surgery (hospitalized for two days) were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion prior to, and on the second post-operative day. Before surgery patients were divided into two groups, SG -spirometer group (n=13), and EG -EPAP group (n=15). Motor physical therapy was standardized for both groups; respiratory therapy (both modalities) started on the day of surgery, in 15-minute sessions. Post-operative results showed similar reduction, in both groups, in the values of vital capacity, forced vital capacity, maximum voluntary ventilation, and inspiratory reserve volume. No changes were found in tidal volume values in SG, neither in expiratory reserve volume in EG. Diaphragmatic and thoracoabdominal motion were less harmed in SG. After bariatric surgery thus incentive spirometry had better effect in maintaining tidal volume, as well as on diaphragmatic and thoracoabdominal motion; while EPAP proved more efficient in re-establishing expiratory reserve volume in the postoperative period.

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Section: Avaliação Pré -Operatóriaunclassified

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

et al. 2009

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“…[27][28][29]36 To overcome these limitations, an alternative method to quantify right hemidiaphragm mobility was developed. 37 It used an indirect approach by B-mode ultrasonography with a perpendicular incidence of the ultrasound beam to the craniocaudal axis because of craniocaudal displacement of the left branches of the portal vein. This technique proved to be a valid tool for indirect assessment of right hemidiaphragmatic mobility because it showed a mean difference between ultrasonography and radiography of only 0.4 mm.…”

Section: Discussionmentioning

confidence: 99%

“…This technique proved to be a valid tool for indirect assessment of right hemidiaphragmatic mobility because it showed a mean difference between ultrasonography and radiography of only 0.4 mm. 37 Considering the same premise, we tried to adapt the described ultrasonographic technique for evaluation of the left hemidiaphragm by measuring the displacement of the hilum and inferior pole of spleen. This alternative approach could be especially interesting because of the greater difficulty in identifying the left hemidiaphragmatic dome due to intervening gas in the splenic flexure, stomach, and bowel.…”

Section: Discussionmentioning

confidence: 99%

Left Hemidiaphragmatic Mobility

Toledo

Kodaira

Massarollo

et al. 2006

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. Methods. Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. Results. The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 × splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 × inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 ± 16.1 mm; P < .05 [hilum]; 18.9 ± 14.2 mm; P < .05 [inferior pole]). Conclusions. These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.

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“…Surprisingly, insofar this has not been studied in BLVR protocols. The US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein was described as an indirect assessment of right hemidiaphragmatic mobility (Toledo, Kodaira et al 2003). Paulin et al (Paulin, Yamaguti et al 2007) created a classification of diaphragmatic dysfunction based on the degree of its mobility.…”

Section: Diaphragmatic Mobility By Ultrasound (Us)mentioning

confidence: 99%

Endoscopic Lung Volume Reduction for Emphysema

Cardoso¹

2012

Topics in Thoracic Surgery

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Right Hemidiaphragmatic Mobility: Assessment with US Measurement of Craniocaudal Displacement of Left Branches of Portal Vein

Abstract: US measurement of craniocaudal displacement of the left intrahepatic branches of the portal vein can be used for indirect assessment of right hemidiaphragmatic mobility.

Cited by 52 publications

References 31 publications

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

Left Hemidiaphragmatic Mobility

Endoscopic Lung Volume Reduction for Emphysema

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