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Seok, Kim, Rha, and Lee: Sonographic evaluation of the dia-phragm in patients with unilateral dia-phragmatic paralysis
Case Report

Ann Clin Neurophysiol 2018;20(2):93-96.

Published online: 20 January 2018

DOI: https://doi.org/10.14253/acn.2018.20.2.93

Sonographic evaluation of the dia-phragm in patients with unilateral dia-phragmatic paralysis

Jung Im Seok1, , Kyung Chan Kim2, Hye Joo Rha1, Sung Rok Lee1

1Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Korea

2Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea

Correspondence to Jung Im Seok Department of Neurology, Catholic Uni-versity of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-3440 Fax: +82-53-654–9786 E-mail: ji-helpgod@hanmail.net

Received 6 March 2018       Revised 21 April 2018       Accepted 16 May 2018

Copyright © 2018 The Korean Society of Clinical Neurophysiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Evaluation of diaphragm function is challenging because no single test has a high diagnostic yield. We describe ultrasound findings in three cases with acquired unilateral diaphragmatic elevation. These cases confirm that sonographic evaluation is a valid tool for identifying dia-phragm dysfunction. In addition, ultrasound measurements of diaphragm thickness and the contractility can be used to determine if a diaphragm is paralyzed and suggest the duration of paralysis (i.e., acute or chronic).

Keywords: Ultrasonography, Diaphragm, Paralysis

References

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Fig. 1.
Ultrasound of the right (A and C) and left (B and D) diaphragm of patient 2. The distance between the two markings (+) is the diaphragm thickness. (A, B) At the end of quiet expiration, the diaphragm is seen as a hypoechoic structure between two layers of hyperechoic fascia. (C) At maximal inspiration, the right diaphragm is seen ‘peeling away' from the chest wall and thickens markedly. (D) At maximal inspiration, the left diaphragm slightly thickens. D, diaphragm; IC, intercostal muscle.
acn-20-93f1.tif
Table 1.
Clinical characteristics, NCS findings, and ultrasound findings of the three patients
  Patient 1 Patient 2 Patient 3
Age 58 71 58
Sex Male Male Female
Symptom None None None
Duration About 10 years 1–4 months 2–10 months
Chest X-ray
Elevation side Left Left Right
Diaphragm ultrasound Right Left Right Left Right Left
 Resting thickness (cm) 0.328 0.183 0.203 0.157 0.171 0.184
 Side-to-side ratioa   0.56d   0.77   0.93
 Maximal thickness (cm) 0.427 0.19 0.58 0.177 0.178 0.57
DTFb (%) 30 4d 186 13d 4d 210
NCSc Right Left Right Left Right Left
Latency (ms) 12.6d 11.7d 8.6 14.2d 8.65d 6.98
CMAP amplitude (mV) 0.1d 0.1d 0.1d 0.1d 0.4 1.2

DTF, diaphragm thickening fraction; NCS, nerve conduction study; CAMP, compound muscle action potential.

a Side-to-side ratio is a thickness ratio defined as the resting thickness of the side with the thinner expressed as a ratio of the larger, contralateral thickness (normal limit, > 0.62).

b The lower normal limit of DTF was 28% for right side and 17% for left side.

c The lower normal limit for latency is 8.62 ms, for amplitude it is 0.2 mV.

d Abnormal values are highlighted in bold.

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