Journal of Ultrasound in Medicine, Vol 20, Issue 6 597-604, Copyright © 2001 by American Institute of Ultrasound in Medicine
Ultrasonographic evaluation of diaphragmatic motion
E. O. Gerscovich, M. Cronan, J. P. McGahan, K. Jain, C. D. Jones and C. McDonald
Department of Radiology, University of California, Davis Medical Center, Sacramento 95817, USA.
OBJECTIVE: To evaluate the technical feasibility and utility of
ultrasonography in the study of diaphragmatic motion at our institution.
METHODS: The study consisted of 2 parts. For part I, in 23 volunteers we
performed 23 studies on 46 hemidiaphragms with excursions documented on
M-mode ultrasonography For part II, in 22 patients we performed 52 studies
in 102 hemidiaphragms. In 50 studies both hemidiaphragms were studied, and
in another 2 studies only 1 hemidiaphragm was studied. Patients' ages
ranged from birth to 66 years (mean, 23 years). There were 16 male and 6
female patients. Indications for the study were (1) suggestion of paralysis
of the diaphragm (n = 22); (2) if the diaphragm was already known to be
paralyzed, for evaluation of response to phrenic nerve or pacer stimulation
(n = 9); and (3) follow-up of previous findings (n = 21). Patients were
examined in the supine position in the longitudinal semicoronal plane from
a subcostal or low intercostal approach. Motion was documented with
real-time ultrasonography and measured with M-mode ultrasonography.
RESULTS: Of the 102 clinical hemidiaphragms studied, findings included
normal motion (n = 42), decreased motion (n = 22), no motion (n = 6),
paradoxical motion (n = 10), positive pacer response (n = 13), negative
pacer response (n = 2), positive phrenic stimulation (n = 6), and negative
phrenic stimulation (n = 1). There were no failures of visualization.
CONCLUSIONS: Ultrasonography proved feasible and useful in evaluating
diaphragmatic motion. In our practice it has replaced fluoroscopy.
Ultrasonography has advantages over traditional fluoroscopy, including
portability, lack of ionizing radiation, visualization of structures of the
thoracic bases and upper abdomen, and the ability to quantify diaphragmatic
motion.
