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Ultrasound imaging of diaphragmatic motion

  • Thoracic imaging
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Pediatric Radiology Aims and scope Submit manuscript

Abstract

The diaphragm is the key muscle of respiration, especially in infants. Diaphragmatic dysfunction and paralysis can have significant implications for medical management and treatment, and they can be challenging to diagnose by clinical parameters alone. Multiple imaging modalities are useful for assessing the diaphragm, but US — specifically M-mode US — offers several distinct advantages and few limitations compared to fluoroscopy, radiography, CT and MRI. The purpose of this manuscript is to discuss the pathophysiology of the diaphragm, review common indications for dynamic diaphragmatic US, describe optimal imaging technique, and discuss how to avoid imaging pitfalls.

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Authors and Affiliations

  1. Department of Radiology, Nemours Children’s Hospital, Wilmington, DE, USA

    Lauren A. May

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Lauren A. May

  3. Department of Radiology, Nemours Children’s Hospital, 13535 Nemours Pkwy., Orlando, FL, 32827, USA

    Monica Epelman

  4. University of Central Florida College of Medicine, Orlando, FL, USA

    Monica Epelman

  5. Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

    Oscar M. Navarro

  6. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Oscar M. Navarro

Authors
  1. Lauren A. May
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  2. Monica Epelman
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  3. Oscar M. Navarro
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Correspondence to Monica Epelman.

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Supplementary Information

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Supplementary file1 (MP4 571 KB)

Online Supplementary Material 1 US in a 13-year-old boy with transverse myelitis and quadriplegia (same boy as in Fig. 3). A Real-time (videoclip) midline (ML) subxiphoid transverse gray-scale US image obtained while the boy was on ventilatory support shows poor motion of both hemidiaphragms. b Real-time (videoclip) midline (ML) subxiphoid transverse gray-scale US imaging obtained while the boy was off ventilatory support shows motion in the left upper quadrant consistent with the expected left diaphragmatic excursion, with absent motion of the right upper quadrant structures and right hemidiaphragm consistent with right diaphragmatic paralysis. The left diaphragmatic excursion appears exaggerated and measures 2.1 cm. Diaphragmatic excursion and paralysis are easier to appreciate off of ventilatory support

Supplementary file2 (MP4 953 KB)

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May, L.A., Epelman, M. & Navarro, O.M. Ultrasound imaging of diaphragmatic motion. Pediatr Radiol 52, 2051–2061 (2022). https://doi.org/10.1007/s00247-022-05430-7

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  • DOI: https://doi.org/10.1007/s00247-022-05430-7

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