Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Ultrasonographic evaluation of the diaphragm

Egyptian Journal of Bronchology volume 13, pages 690–698 (2019)Cite this article

Abstract

Background

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.

Objective

The 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 methods

In 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.

Results

Cases 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%).

Conclusion

US 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.

References

  1. Yeh HC, Halton KP, Gray CE. Anatomic variations and abnormalities in the diaphragm seen with US. Radiographics 1990; 10:1019–1030.

    Article  CAS  Google Scholar 

  2. Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve 2013; 47:319–329.

    Article  Google Scholar 

  3. Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001; 20:597–604.

    Article  CAS  Google Scholar 

  4. Chavhan GB, Babyn PS, Cohen RA, Langer JC. Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics 2010; 30:1797–1817.

    Article  Google Scholar 

  5. Houston JG, Morris AD, Howie CA, Reid JL, Mcmillan N. Technical report: quantitative assessment of diaphragmatic movement – a reproducible method using ultrasound. Clin Radiol 1992; 46:405–407.

    Article  CAS  Google Scholar 

  6. Epelman M, Navarro OM, Daneman A, Miller SF. M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients. Pediatr Radiol 2005; 35:661–667.

    Article  Google Scholar 

  7. Gottesman E, Mc Cool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997; 155:1570–1574.

    Article  CAS  Google Scholar 

  8. Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008; 133:737–743.

    Article  Google Scholar 

  9. Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics 2012; 32: E51–E70.

    Article  Google Scholar 

  10. Boon AJ, Harper CJ, Ghahfarokhi LS, Strommen JA, Watson JC, Sorenson EJ. Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle Nerve 2013; 47:884–889.

    Article  Google Scholar 

  11. Goligher EC, Laghi F, Detsky ME, Farias P, Murray A, Brace D, et al. Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: feasibility, reproducibility and validity. Intensive Care Med 2015; 41:642–649.

    Article  Google Scholar 

  12. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Enl J Med 2012; 366:932–942.

    Article  CAS  Google Scholar 

  13. Kantarci F, Mihmanli I, Demirel MK, Harmanci K, Akman C, Aydogan F, et al. Normal diaphragmatic motion and the effects of body composition: determination with M-mode sonography. J Ultrasound Med 2004; 23:255–260.

    Article  Google Scholar 

  14. Jung B, Moury PH, Mahul M, de Jong A, Galia F, Prades A, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med 2016; 42:853–861.

    Article  Google Scholar 

  15. Farghaly S, Hasan AA, Makhlouf HA. Assessment of ventilator-induced diaphragmatic dysfunction in patients with chronic obstructive pulmonary disease using transthoracic ultrasonography. Egypt J Bronchol 2018; 12:218–225.

    Article  Google Scholar 

  16. El Naggara TA, Dwedara IA, Abd-Allahb EFA. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Egypt J Bronchol 2019; 13:191–195.

    Article  Google Scholar 

  17. Lerolle N, Guérot E, Dimassi S, Zegdi R, Faisy C, Fagon JY, et al. Ultrasonographic diagnostic criterion for severe diaphragmatic dysfunction after cardiac surgery. Chest 2009; 135:401–407.

    Article  Google Scholar 

  18. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135:391–400.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt

    Youssriah Y. Sabri, Ahmed A. M. Baz & Amal A. M. Aglan

  2. Department of Pulmonology, Faculty of Medicine, Cairo University, Cairo, Egypt

    Sabah A. M. Hussein MD

Authors
  1. Youssriah Y. Sabri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabah A. M. Hussein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed A. M. Baz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amal A. M. Aglan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sabah A. M. Hussein MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sabri, Y.Y., Hussein, S.A.M., Baz, A.A.M. et al. Ultrasonographic evaluation of the diaphragm. Egypt J Bronchol 13, 690–698 (2019). https://doi.org/10.4103/ejb.ejb_73_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_73_19

Keywords