Abstract
BackgroundUltrasonography is a promising technique for structural and functional evaluation of the diaphragm. It is accurate, reproducible, and portable with no ionizing radiation. Multiple studies have reported ultrasonography as the modality of choice for evaluation of the diaphragm.ObjectiveThe aim was to assess the role of ultrasound (US) in the evaluation of the diaphragm, either normal or abnormal, through evaluating its morphology, integrity, and measuring different parameters such as diaphragmatic thickness, thickening fraction, and excursion with proper assessment of supra/infradiaphragmatic lesions that affect the diaphragm.Patients and methodsIn all, 118 patients were recruited from the Chest and Radiology Departments, Cairo University, in the period from January to July 2019. All patients were subjected to history taking, clinical examination, and ultrasonographic assessment of the diaphragm. High-frequency linear transducer of 7.5–12 MHz was used for imaging the diaphragm and measuring its thickness. A low-frequency curvilinear transducer with a frequency of 3.5–5 MHz was used for assessing diaphragmatic excursion.ResultsCases were grouped into two groups, those with normal US findings of the diaphragm represented group A, while patients with any diaphragmatic abnormality represented group B. Group B included 41 patients with intrinsic (56.09%) and extrinsic diaphragmatic abnormalities (46.34%). Five (12.2%) cases have thickened diaphragm; two (4.9%) cases have thinned-out diaphragm; two (4.9%) cases showed congenital diaphragmatic defects; three (7.3%) cases showed acquired diaphragmatic defects; 10 (24.4%) cases showed diaphragmatic weakness; and nine (21.95%) cases showed diaphragmatic paralysis (7.6%).ConclusionUS is the technique of choice for assessing diaphragmatic movement on suspicion of malfunctioning. Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm.
Highlights
The diaphragm is the major respiratory muscle
Dysfunction can be caused by conditions either directly involving the diaphragm, such as trauma, cardiothoracic surgery, or adjacent thoracic and abdominal pathology [1]
All radiologic modalities can be used for anatomic imaging, functional imaging is mainly performed with fluoroscopy, ultrasonography, and magnetic resonance (MR) fluoroscopy [3]
Summary
The diaphragm is the major respiratory muscle. Dysfunction can be caused by conditions either directly involving the diaphragm, such as trauma, cardiothoracic surgery, or adjacent thoracic (e.g. basal pulmonary atelectasis, pleural effusion, pneumonia, or tumors) and abdominal pathology (e.g. upper abdominal masses, extensive abdominal fluid) [1]. Diaphragm movement can be affected by central nervous system diseases, phrenic nerve involvement, motor neuron disease and diseases of the neuromuscular junction [2]. Imaging of the diaphragm can be anatomic or functional. US focuses mainly on the posterior and lateral parts of the diaphragm, which are the muscular crural components innervated by the phrenic nerve, rather than the anterior central tendon seen in fluoroscopy, which moves 40% less with respiration [5]. Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm. It is accurate, reproducible, and portable with no ionizing radiation. Multiple studies have reported ultrasonography as the modality of choice for evaluation of the diaphragm
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