Ultrasonographic evaluation of diaphragmatic motion

Objective. To evaluate the technical feasibility and utility of ultrasonogr aphy 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 st udies on 46 hemidiaphragms with excursions documented on M-mode ultrasonogr aphy For part II, in 22 patients we performed 52 studies in 102 hemidiaphra gms. In 50 studies both hemidiaphragms were studied, and in another 2 studi es only 1 hemidiaphragm was studied. Patients' ages ranged from birth to 66 years (mean, 23 years). There were 16 male and 6 female patients. Indicati ons 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 o f response to phrenic nerve or pacer stimulation (n = 9); and (3) follow-up of previous findings (n = 21). Patients were examined in the supine positi on in the longitudinal semicoronal plane from a subcostal or low intercosta l approach. Motion was documented with real-time ultrasonography and measur ed with M-mode ultrasonography. Results. Of the 102 clinical hemidiaphragms studied, findings included normal motion (n = 42), decreased motion (n = 2 2), 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 e valuating diaphragmatic motion. In our practice it has replaced fluoroscopy . Ultrasonography has advantages over traditional fluoroscopy, including po rtability, lack of ionizing radiation, visualization of structures of the t horacic bases and upper abdomen, and the ability to quantify diaphragmatic motion.