Further Studies on Respiratory Kymography in Acute Abdominal Conditions

Abstract

The results of roeiitgenkymographic examinations of the respiratory movements of the diaphragm and ribs in various acute abdominal conditions were reported by the author in an earlier paper (1960). To further estimate the diagnostic value of the method, a greater variety of acute abdominal cases has been investigated. The results of these studies form the object of the present paper. Roentgenkymographic examinations of the respiratory mechanics were earlier carried out on a small scale by Stumpf (1931), Dahm (1933), and Weber (1932). They observed reduced diaphragmatic excursions or diaphragmatic paralysis in some abdominal conditions. Epstein (1955) published the results of kymographic examinations in 100 normal subjects and 150 patients with pulmonary and abdominal disease. His examinations were made in ordinary breathing, and the exposure time was three seconds. These workers did not consider the results encouraging from the diagnostic point of view. Technic The apparatus and technic were the same as those employed in earlier investigations (Schmidt 1960, 1963; Edling and Schmidt, 1961). The kymograph is supported on legs 35 cm high and is fitted with two movable lead plates, each of which has a slit 1 mm wide and 50 cm long. Above these plates lies the moving tray to hold the cassette. The tray is operated by an hydraulic pump similar to that of a Potter grid. The patient is examined in supine position with the kymograph placed above his chest and the tube below the table. The roentgen beam is centered over the spine and is limited laterally to include the thoracic wall on each side and longitudinally to about 10–12 cm above and below the diaphragm (Fig. 1). Each plate is placed under fluoroscopic control over one side of the diaphragm and lower half of the chest so that the slits lie parallel to the long axis of the body and about 2 fingerbreadths medial to the lateral thoracic walls. The left slit also lies lateral to the heart whenever possible. It is important that the position of the slits on both sides is the same in relation to the lateral thoracic walls. Both sides are exposed simultaneously on the same 30 × 40 cm film placed transversely. During the exposure the tray with the cassette travels for a distance of 6 cm from the patient's left to his right. Exposure factors are 100 to 120 kv, 10 ma, 15 seconds, and 70 cm focusfilm distance. The relatively long exposure (but low ma) is necessary for recording at least two or three respiratory cycles during deep respiration. Two films are exposed, one during ordinary and one during deep respiration. The purpose of exposing two films is that the two tracings often show different wave patterns in addition to different amplitudes. Deep respiration may be considered as a voluntary functional test. We thus obtain a record of the movements of a 1-mm-broad segment of the diaphragm and the lower part of the chest on each side.