M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients.
ABSTRACT The use of M-mode sonography for evaluation of diaphragmatic motion has only been previously reported in small series of children, and its use is not widespread among pediatric radiologists.
To present our experience with M-mode sonography in the evaluation of diaphragmatic motion in a large number of children with suspected diaphragmatic paralysis, to describe the technique used and to correlate sonographic findings with chest radiographs and clinical outcome.
Retrospective analysis of all M-mode sonograms performed in children from September 1999 to December 2003. The available chest radiographs and the clinical findings were reviewed and correlated with the sonographic findings.
A total of 742 hemidiaphragms were evaluated in 278 children. There was no visualization of the left hemidiaphragm in 2 children (0.71%). Movement of the right hemidiaphragm was normal in 238 and abnormal in 131. Movement of the left hemidiaphragm was normal in 232 and abnormal in 135. Abnormal diaphragmatic movement was present in 118 (63%) of 187 children in whom chest radiographs had shown normal position of the hemidiaphragms. Follow-up examinations were obtained in 56 children, revealing improvement in diaphragmatic motion in 26, no change in 23 and deterioration of motion in seven.
M-mode sonography should be the modality of choice to assess diaphragmatic motion, as it can easily depict diaphragmatic dysfunction and allows comparison of changes in follow-up studies. Normal chest radiographs are poor predictors of normal diaphragmatic motion.
Article: ULTRASONIDO UNA ALTERNATIVA EN LA EVALUACIÓN DEL DIAFRAGMA EN NIÑOS CON DISTROFIA MUSCULAR DE DUCHENNE[show abstract] [hide abstract]
ABSTRACT: Abstract: The outcome of children with Duchenne muscular dystrophy (DMD) depends on respiratory involvement, so a timely assessment of the diaphragm is required. We propose ultrasound (US) imaging as an alternative in the evaluation of the diaphragm in children with DMD, correlating diaphragmatic thickness and excursion values yielded by the US study with pulmonary function tests. We conducted a case-control study including 27 children, 15 controls and 12 patients. Excursion and thickness of both hemidiaphragms were measured and spirometry was performed. The DMD group showed less excursion and a significantly higher thickness of the right hemidiaphragm; 60% of patients showed spirometric restrictive pattern and FEV1, FVC, PEF and PIM values were significantly lower. We found a negative trend when correlating diaphragmatic excursion with pulmonary function tests. We conclude that the US technique is suitable for screening alterations in diaphragmatic excursion and thickness in children with DMD, since it provides supporting data to pulmonary function tests. Keywords: DiaphRevista Chilena de Radiologia 01/2011; 1(17):34-43.
Article: Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications.[show abstract] [hide abstract]
ABSTRACT: The use of ultrasonography has become increasingly popular in the everyday management of critically ill patients. It has been demonstrated to be a safe and handy bedside tool that allows rapid hemodynamic assessment and visualization of the thoracic, abdominal and major vessels structures. More recently, M-mode ultrasonography has been used in the assessment of diaphragm kinetics. Ultrasounds provide a simple, non-invasive method of quantifying diaphragmatic movement in a variety of normal and pathological conditions. Ultrasonography can assess the characteristics of diaphragmatic movement such as amplitude, force and velocity of contraction, special patterns of motion and changes in diaphragmatic thickness during inspiration. These sonographic diaphragmatic parameters can provide valuable information in the assessment and follow up of patients with diaphragmatic weakness or paralysis, in terms of patient-ventilator interactions during controlled or assisted modalities of mechanical ventilation, and can potentially help to understand post-operative pulmonary dysfunction or weaning failure from mechanical ventilation. This article reviews the technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic function in ICU patients.European Journal of Intensive Care Medicine 01/2013; · 5.17 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.The British journal of radiology 06/2011; 85(1012):411-4. · 2.11 Impact Factor