Value of fluoroscopy in patients with suspected bilateral hemidiaphragmatic paralysis.

Ch'en, I Y; Armstrong, J D

doi:10.2214/ajr.160.1.8416639

Cited by 22 publications

(12 citation statements)

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“…A likely explanation of this discrepancy may be found in the difference of methods used to determine diaphragm motion. The study by Takazakura et al [16], in fact, was conducted by using a magnetic resonance system, while another study used fluoroscopic assessment of the diaphragm [17].…”

Section: Discussionmentioning

confidence: 99%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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Background: Assessing diaphragm mobility is important to detect malfunctions or impending exhaustion and to evaluate the effects of many chest and abdominal conditions on respiratory mechanics. Amongst several imaging methods, ultrasonography represents the only noninvasive, nonionizing imaging technique widely available for the direct assessment of diaphragm excursion. Objectives: the aim of this study is to prospectively assess the supine diaphragmatic motion amplitude, intra- and inter-observer agreement, and anthropometric correlates of diaphragm motion variability, measured through M-mode ultrasonography, in a sample of healthy volunteers. Methods: One-hundred healthy volunteers were considered eligible for the study. Instead of B-mode imaging, the M-mode technique was used to achieve a more accurate measurement of diaphragm motion. To assess intra-observer variability, 3 consecutive measurements (M-mode and B-mode) of the right dome motion were obtained at every session. To test for inter-rater reliability, the subjects were asked to provide 2 more diaphragm motion measurements every week, each performed by 2 experienced operators, and 42 subjects accepted. Results: Diaphragmatic motion was positively correlated with height and weight both at quiet (Spearman’s coefficient = 0.514, p < 0.001 and 0.314, p = 0.038) and deep breathing (Spearman’s coefficient = 0.342, p = 0.001 and 0.225, p = 0.024, respectively) and negatively correlated with age, but only during deep breathing (Spearman’s coefficient = –0.272, p = 0.006). Intra-observer agreement degree on all 3 measurements was excellent during both quiet and deep breathing, with a Cronbach’s alpha of 0.793 and 0.901, respectively, and an intra-class coefficient of 0.797 and 0.900, respectively. Similarly, the degree of inter-observer agreement achieved a Cronbach’s alpha of 0.638 and 0.776, and an inter-class coefficient of 0.632 and 0.778, respectively. Deep breathing was associated with sex only in linear multivariable models (B = –10.14; 95% confidence interval [CI] –17.86, –2.41; p = 0.011), while quiet breathing resulted to be affected by height only (B = 30.05; 95% CI 0.79–59.31; p = 0.044). Conclusions: Diaphragm excursion measurements using the M-mode technique were accurate and could be reproduced also when obtained in recumbent patients. After adjustments, the main predictors of diaphragmatic motion were sex and height, which should be considered to design a specifically tailored study and to develop normality reference equations.

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Section: Discussionmentioning

confidence: 99%

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

et al. 2018

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“…Despite its ease of use, the test has several drawbacks: it has only rarely been compared to a reference technique, making estimates of its sensitivity and specificity imprecise; it is dependent on patient effort and cooperation and only provides a semi-quantitative evaluation of diaphragm function, making repetitive prospective measurements difficult to compare. In addition, it should not be used in the setting of bilateral diaphragm weakness, as the abnormal breathing pattern observed in this setting may obscure radiological findings and result in false negatives [98,113,114,115]. …”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Dubé

Dres

2016

JCM

157

109

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The diaphragm is the main inspiratory muscle, and its dysfunction can lead to significant adverse clinical consequences. The aim of this review is to provide clinicians with an overview of the main causes of uni- and bi-lateral diaphragm dysfunction, explore the clinical and physiological consequences of the disease on lung function, exercise physiology and sleep and review the available diagnostic tools used in the evaluation of diaphragm function. A particular emphasis is placed on the clinical significance of diaphragm weakness in the intensive care unit setting and the use of ultrasound to evaluate diaphragmatic action.

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“…Supine positioning during fluoroscopy accentuates paradoxical diaphragmatic and thoracoabdominal motion and minimizes compensatory breathing patterns in BDP. A solely standing position assessment can lead to a false-negative diagnosis, 11 as occurred in our patient's initial diaphragmatic fluoroscopy.…”

Section: Discussionmentioning

confidence: 79%

Brachial Neuritis With Bilateral Diaphragmatic Paralysis Following Herpes Zoster: A Case Report

Hoque

Schwendimann²,

Liendo³

et al. 2008

Journal of Clinical Neuromuscular Disease

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We present a case of supine respiratory failure due to a bilateral diaphragmatic paralysis associated with brachial neuritis secondary to thoracic herpes zoster. Fluoroscopy in both the standing and supine positions revealed bilateral diaphragmatic paralysis accentuated in the supine position. To our knowledge, this is the first case of thoracic herpes zoster associated with brachial neuritis and bilateral diaphragmatic paralysis.

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Value of fluoroscopy in patients with suspected bilateral hemidiaphragmatic paralysis.

Cited by 22 publications

References 0 publications

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers

Diaphragm Dysfunction: Diagnostic Approaches and Management Strategies

Brachial Neuritis With Bilateral Diaphragmatic Paralysis Following Herpes Zoster: A Case Report

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