Some radiological observations on the range of movement of the diaphragm

Simon, George R.; Bonnell, J.A.; Kazantzis, G.; Waller, R. E.

doi:10.1016/s0009-9260(69)80181-9

Cited by 34 publications

(27 citation statements)

References 2 publications

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“…Fluoroscopy of the diaphragm dome may be the most commonly used indirect technique to assess diaphragm paralysis (13)(14)(15). The fluoroscopic motion of a hemidiaphragm during a sniff maneuver is reduced or reversed in patients with unilateral diaphragm paralysis.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound evaluation of the paralyzed diaphragm.

Gottesman

McCool²

1997

Am J Respir Crit Care Med

298

208

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Ultrasound has been used to evaluate diaphragm thickness in the zone of apposition of the diaphragm to the rib cage. The purpose of this study was to determine if ultrasonography could distinguish between a paralyzed and normally functioning diaphragm. We predicted that a paralyzed diaphragm would be atrophic and not shorten, therefore it would be thin and not thicken during inspiration. Thirty subjects (five with bilateral diaphragm paralysis, seven with unilateral diaphragm paralysis, three with inspiratory weakness but normally functioning diaphragms, and 15 healthy control subjects) had diaphragm ultrasound performed with a 7.5 to 10.0 MHz transducer placed over the lower rib cage in the mid-axillary line. The thickness of the diaphragm (tdi) was measured to the nearest 0.1 mm at FRC (t(di)FRC) and TLC (t(di)TLC). Diaphragm thickening during inspiration (delta t(di)) was calculated as (t(di)TLC - t(di)FRC)/t(di)FRC. In patients with unilateral paralysis, t(di) and delta t(di) for the paralyzed hemidiaphragm were significantly less than those values for the normally functioning hemidiaphragm (1.7 +/- 0.2 mm versus 2.7 +/- 0.5 mm [mean + SD] p < 0.01 for t(di), and -8.5 +/- 13% versus 65 +/- 26% [p < 0.001] for delta t(di)). The t(di) and delta t(di) for patients with bilateral diaphragm paralysis were significantly less than those values for the healthy volunteers (1.8 +/- 0.2 versus 2.8 +/- 0.4 and -1 +/- 15% versus 37 +/- 9% for t(di) and delta t(di), respectively) (p < 0.001). We conclude that ultrasound measurements of t(di) and delta t(di) can be used to determine if a diaphragm is paralyzed and confirm our predictions that a chronically paralyzed diaphragm is atrophic and does not thicken during inspiration.

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Section: Discussionmentioning

confidence: 99%

Ultrasound evaluation of the paralyzed diaphragm.

Gottesman

McCool²

1997

Am J Respir Crit Care Med

298

208

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“…These factors are important because diaphragmatic muscle dysfunction can be observed in various clinical situations, such as in patients with muscular dystrophy or phrenic nerve injury, in patients undergoing thoracic and/or abdominal surgeries and in patients with chronic obstructive pulmonary disease [10][11][12] . Several studies have been performed to evaluate diaphragmatic mobility by the radiographic method 7,[13][14][15][16][17] ; however, there is no examination standardization, and there is also a lack of studies to verify the reliability of the method. A reliable instrument is known to be able to measure the same parameters at different times, regardless of whether the same evaluator performs the measurements, thus ensuring the reliability of the results.…”

Section: Introductionmentioning

confidence: 99%

“…Simon et al 13 observed a diaphragmatic value range from 0 to 85 mm, Houston et al 25 observed a range from 23 to 97 mm, Kantarci et al 27 observed a range from 25 to 84 mm and Boussuges et al 8 observed a range from 36 to 92 mm. This large variability in the values of diaphragmatic mobility might be due to the patient BMI, which is a useful measure for assessments of excess body fat; according to the international classifications 28 , adults with a BMI between 25 and 29.9 are considered overweight.…”

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confidence: 98%

High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals

Saltiél¹,

Grams²,

Pedrini³

et al. 2013

Braz. J. Phys. Ther.

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| Background: Diaphragmatic evaluation is crucial in clinical practice, and no studies have reported the intraand interobserver reproducibilities of the radiographic method to evaluate diaphragmatic mobility. Objective: To analyze the reliability of radiographic measurement as a method for assessing the mobility of the left and right hemidiaphragms. Method: Forty-two patients, who were waiting for cholecystectomy surgery, were evaluated relative to the following parameters: physical examination, pulmonary function and radiographic evaluation. The measure of mobility of each hemidiaphragm was randomly determined by two physical therapists at two different times. The intra-and interobserver reproducibilities of the measurements were determined by the intraclass correlation coefficient (ICC[2,1]) and the 95% confidence interval (CI). The Bland-Altman plot was also used. The level of significance was 5%. Keywords: physical therapy; diaphragm; radiographic; reproducibility of the tests. HOW TO CITE THIS ARTICLESaltiel RV, Grams ST, Pedrini A, Paulin E. High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals. Braz J Phys Ther.

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“…Physiologists and radiologists have studied the normal functions of the diaphragm by various methods (Keefer, 1957;Bergofsky, 1964;Boyd, 1969;Mognoni, Saibene, and Sant 'Ambrogio, 1969;Simon, Bonnell, Kazantzis, and Waller, 1969) and have reported the effects of paralysis (Couch, 1953;Douglass and Clagett, 1960;McKelden Smith, 1964), obesity (Lourenco, 1969), and emphysema (Barach and Seaman, 1963). Recently, it has iPresent address: Department of Pathology, The University, Southampton 2Present address: Department of Pathology, Brompton Hospital, London S.W.3, and London Chest Hospital, E.2 been shown that the excursions of the diaphragm, as measured radiologically, are directly proportional to the compliance of the lungs (Milne and Bass, 1969).…”

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confidence: 99%

Size of the diaphragm in chronic bronchitis

Steele

Heard

1973

Thorax

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Diaphragms were dissected out intact from 29 male and 9 female cadavers at necropsy. Fifteen of the males and eight of the females were grouped as controls, having no history of chest disease. Fourteen of the males and one female gave a history of chronic bronchitis. Point-counting and other methods were employed to measure the mean area, thickness, and volume of the diaphragmatic muscle, excluding the central tendon.The results showed t-hat the diaphragm was reduced in area, thickness, and volume in the chronic bronchitics, the figures being 350 cm2, 0 29 cm, and 99 7 cm3 respectively in male controls, and 295 cm2, 0-23 cm, and 68-7 cm3 in the bronchitics. In the female controls, the values were significantly lower than in the male controls. The one female bronchitic had a muscle volume of only 40 cm3. The male controls were similar in height to the bronchitics, but their mean weight was higher, being 69 4 kg against 56 0 kg in male bronchitics.It is concluded that the diaphragm is smaller in chronic bronchitics than in controls at necropsy and that while a major factor in causation is an associated low body weight, other factors such as the mechanical consequences of flattening of the diaphragm, longstanding reduction in physical activity, and other diseases such as cancer may also play a part. No histological changes by nonquantitative methods were found in the diaphragm in the chronic bronchitics, but muscle fibre shrinkage was suspected. By contrast, a few cases of asthma examined to date have shown no evidence of reduction in diaphragm size. The mechanical implications are discussed.Modern quantitative methods derived from the studies of geologists in the 1930s have been adapted by pathologists to measure changes in various tissue components in disease. In chronic bronchitis and emphysema, for example, the methods have been used to demonstrate enlargement of the bronchial mucous glands and hyperplasia of bronchial smooth muscle (Heard, 1969). The amount of emphysema in a specimen of lung can be measured accurately by a choice of several different procedures. Such information, especially when compared with clinical and physiological data from the same patients, is improving our understanding of chronic bronchitis and emphysema and helping to raise standards of treatment.

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Some radiological observations on the range of movement of the diaphragm

Cited by 34 publications

References 2 publications

Ultrasound evaluation of the paralyzed diaphragm.

Ultrasound evaluation of the paralyzed diaphragm.

High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals

Size of the diaphragm in chronic bronchitis

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