"Central nervous system:"
"post-viral neuropathy"
"Parsonage-Turner brachial plexus neuropathy"
"Erb’s palsy"
"ACR Appropriateness Criteria 2024 recommend CT to evaluate diaphragmatic elevation 19, however although atrophy can be rapid following spinal cord transection 21, atrophy can also be slowly progressive over more than one year 20. In these cases, dynamic assessment with ultrasound or fluoroscopy would be necessary to detect abnormal function."
Expected headings
"Central nervous system:"
"Peripheral nervous system"
"Phrenic nerve dysfunction"
"Myopathies"
"Fluoroscopy"
"Diaphragmatic paralysis, diaphragmatic paresis or diaphragmatic palsy may be first suspected when a newly elevated hemidiaphragm is seen on a chest radiograph. Bilateral paralysis is often overlooked because both hemidiaphragms are elevated and there is no normal diaphragm to compare; this can lead to long delays in diagnosis."
"Fluoroscopic examination of the diaphragm ("sniff test") is useful in diagnosing diaphragmatic paralysis. In normal individuals, both hemidiaphragms typically descend with inspiration. In cases of unilateral diaphragmatic paralysis, the affected side may demonstrate paradoxical upward motion. There is considerable normal variation however depending on the contribution of thoracic, diaphragmatic and abdominal breathing; some normal people will demonstrate paradoxical motion of the anterior or the entire diaphragm. Also, in the erect position the abdominal musculature can work to simulate normal function. This effect is minimised in the recumbent position 14."
"In an adult patient diaphragmatic motion should be >1 cm when observing diaphragmatic craniocaudal excursion in the mid-clavicular line 8. The ability to apply this information and predict the success of weaning a patient from mechanical ventilation tends to be more robust when one measures the contractile nature of the diaphragmatic muscle itself. Medial angulation from a sagittal transducer position in the mid-axillary line allows visualisation of the striated, mixed echogenicity band just cephalad to the liver. After placing an M-mode line, one may pause the recording and measure the end-expiratory and end-inspiratory figures, the latter of which should be larger, and calculate a diaphragmatic thickening fraction; values above 30%, indicating no sonographic diaphragmatic dysfunction, have been found to be 71% specific for predicting extubation success 9."
"compression by tumour, aneurysm or goitre"
"Fluoroscopic examination of the diaphragm ("sniff test") is useful in diagnosing diaphragmatic paralysis. In normal individuals, both hemidiaphragms typically descend with inspiration. In cases of unilateral diaphragmatic paralysis, the affected side may demonstrate paradoxical upward motion. There is considerable normal variation however depending on the contribution of thoracic, diaphragmatic and abdominal breathing; some normal people will demonstrate paradoxical motion of the anterior or the entire diaphragm. Also, in the erect position the abdominal musculature can work to simulate normal function. This effect is minimised in the recumbent position 14."
"Fluoroscopic examination of the diaphragm ("sniff test") is useful in diagnosing diaphragmatic paralysis. In normal individuals, both hemidiaphragms typically descend with inspiration. In cases of unilateral diaphragmatic paralysis, the affected side may demonstrate paradoxical upward motion. There is considerable normal variation however depending on the contribution of thoracic, diaphragmatic and abdominal breathing; some normal people will demonstrate paradoxical motion of the anterior or the entire diaphragm. Also, in the erect position the abdominal musculature can work to simulate normal function. This effect is minimised in the recumbent position 14."