Diaphragmatic paralysis other diagnostic studies: Difference between revisions
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{{Diaphragmatic paralysis}} | {{Diaphragmatic paralysis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{MA}} | ||
==Overview== | ==Overview== | ||
Other diagnostic studies for diphragmatic paralysis include [[pulmonary function test]] which demonstrates decrease in [[vital capacity]] in diaphragmatic paralysis. Maximal inspiratory pressure (MIP) can be decreaed. [[Electromyography]] and [[polysomnography]] are other diagnostic studies. | |||
Other diagnostic studies for [ | |||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
==== Pulmonary function test: ==== | ==== Pulmonary function test: ==== | ||
* Spirometry in the supine and sitting positions may be helpful in the diagnosis of diaphragmatic paralysis. Findings suggestive of diaphragmatic paralysis include: | * [[Spirometry]] in the [[supine]] and sitting positions may be helpful in the diagnosis of diaphragmatic paralysis. Findings suggestive of diaphragmatic paralysis include: | ||
** Unilateral diaphragmatic paralysis: | ** Unilateral diaphragmatic paralysis:<ref name="pmid3752705">{{cite journal |vauthors=Lisboa C, Paré PD, Pertuzé J, Contreras G, Moreno R, Guillemi S, Cruz E |title=Inspiratory muscle function in unilateral diaphragmatic paralysis |journal=Am. Rev. Respir. Dis. |volume=134 |issue=3 |pages=488–92 |date=September 1986 |pmid=3752705 |doi=10.1164/arrd.1986.134.3.488 |url= |author=}}</ref> | ||
*** Mild decrease in [[vital capacity]] (VC): 75% of the predicted value and further decrease (10% to 20% in the supine position) | |||
*** Functional residual capacity (FRC) and total lung capacity (TLC) are usually unchanged. | *** [[Functional residual capacity]] (FRC) and [[total lung capacity]] (TLC) are usually unchanged. | ||
** Bilateral diaphragmatic paralysis: | ** Bilateral diaphragmatic paralysis: | ||
*** Decrease in vital capacity (VC): 50 % of the predicted value | *** Decrease in [[vital capacity]] (VC): 50 % of the predicted value and further decrease (30% to 50% in the supine position )<ref name="pmid3202460">{{cite journal |vauthors=Laroche CM, Carroll N, Moxham J, Green M |title=Clinical significance of severe isolated diaphragm weakness |journal=Am. Rev. Respir. Dis. |volume=138 |issue=4 |pages=862–6 |date=October 1988 |pmid=3202460 |doi=10.1164/ajrccm/138.4.862 |url= |author=}}</ref> | ||
*** Total lung capacity may be reduced | *** [[Total lung capacity]] may be reduced | ||
*** | *** [[Residual volume]] (RV) may be elevated<ref name="pmid3354995">{{cite journal |vauthors=Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M |title=Assessment of diaphragm weakness |journal=Am. Rev. Respir. Dis. |volume=137 |issue=4 |pages=877–83 |date=April 1988 |pmid=3354995 |doi=10.1164/ajrccm/137.4.877 |url= |author=}}</ref> | ||
==== Maximal inspiratory pressure (MIP) : ==== | ==== Maximal inspiratory pressure (MIP) : ==== | ||
* MIP | * MIP shows the strength of the [[diaphragm]]. | ||
* MIP can be decreased: | * MIP can be decreased: | ||
** Less than 60% of the predicted value in unilateral diaphragmatic paralysis<ref name=" | ** Less than 60% of the predicted value in unilateral diaphragmatic paralysis<ref name="pmid3202460" /> | ||
** Less than 30% of the predicted value in bilateral diaphragmatic paralysis | ** Less than 30% of the predicted value in bilateral diaphragmatic paralysis | ||
* Maximal expiratory pressure (MEP) is normal. | * Maximal expiratory pressure (MEP) is normal. | ||
* MEP/MIP >2 is supportive of | * MEP/MIP >2 is supportive of the diagnosis of diaphragmatic paralysis. | ||
==== Electromyography ==== | ==== Electromyography ==== | ||
* It is not usullay done because it is very invasive. | * It is not usullay done because it is very invasive. | ||
* Electromyography ( EMG) is not very useful in unilateral diaphragmatic paralysis. | * [[Electromyography]] ([[EMG]]) is not very useful in unilateral diaphragmatic paralysis. | ||
* Electromyography ( EMG) in bilateral diaphragmatic paralysis may reveal neuropathic or myopathic pathern besed on the | * [[Electromyography]] ([[EMG]]) in bilateral diaphragmatic paralysis may reveal [[neuropathic]] or [[myopathic]] pathern besed on the etiology. <ref name="pmid15595343">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |date=December 2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url= |author=}}</ref> | ||
* Absence of an EMG signal is seen in complete transection of the phrenic nerves | * Absence of an [[EMG]] signal is seen in complete [[transection]] of the [[phrenic nerves]] | ||
*[ | ==== Polysomnography ==== | ||
* [[Dyspnea]] and disturbed sleep are usully seen in bilateral diaphragmatic paralysis. It is better that overnight [[polysomnography]] is done to rule out sleep related disorders that cause breathing dysfunction. <ref name="pmid27652831">{{cite journal |vauthors=Oruc O, Sarac S, Afsar GC, Topcuoglu OB, Kanbur S, Yalcinkaya I, Tepetam FM, Kirbas G |title=Is polysomnographic examination necessary for subjects with diaphragm pathologies? |journal=Clinics (Sao Paulo) |volume=71 |issue=9 |pages=506–10 |date=September 2016 |pmid=27652831 |pmc=5004572 |doi=10.6061/clinics/2016(09)04 |url= |author=}}</ref> | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]
Overview
Other diagnostic studies for diphragmatic paralysis include pulmonary function test which demonstrates decrease in vital capacity in diaphragmatic paralysis. Maximal inspiratory pressure (MIP) can be decreaed. Electromyography and polysomnography are other diagnostic studies.
Other Diagnostic Studies
Pulmonary function test:
- Spirometry in the supine and sitting positions may be helpful in the diagnosis of diaphragmatic paralysis. Findings suggestive of diaphragmatic paralysis include:
- Unilateral diaphragmatic paralysis:[1]
- Mild decrease in vital capacity (VC): 75% of the predicted value and further decrease (10% to 20% in the supine position)
- Functional residual capacity (FRC) and total lung capacity (TLC) are usually unchanged.
- Bilateral diaphragmatic paralysis:
- Decrease in vital capacity (VC): 50 % of the predicted value and further decrease (30% to 50% in the supine position )[2]
- Total lung capacity may be reduced
- Residual volume (RV) may be elevated[3]
- Unilateral diaphragmatic paralysis:[1]
Maximal inspiratory pressure (MIP) :
- MIP shows the strength of the diaphragm.
- MIP can be decreased:
- Less than 60% of the predicted value in unilateral diaphragmatic paralysis[2]
- Less than 30% of the predicted value in bilateral diaphragmatic paralysis
- Maximal expiratory pressure (MEP) is normal.
- MEP/MIP >2 is supportive of the diagnosis of diaphragmatic paralysis.
Electromyography
- It is not usullay done because it is very invasive.
- Electromyography (EMG) is not very useful in unilateral diaphragmatic paralysis.
- Electromyography (EMG) in bilateral diaphragmatic paralysis may reveal neuropathic or myopathic pathern besed on the etiology. [4]
- Absence of an EMG signal is seen in complete transection of the phrenic nerves
Polysomnography
- Dyspnea and disturbed sleep are usully seen in bilateral diaphragmatic paralysis. It is better that overnight polysomnography is done to rule out sleep related disorders that cause breathing dysfunction. [5]
References
- ↑ Lisboa C, Paré PD, Pertuzé J, Contreras G, Moreno R, Guillemi S, Cruz E (September 1986). "Inspiratory muscle function in unilateral diaphragmatic paralysis". Am. Rev. Respir. Dis. 134 (3): 488–92. doi:10.1164/arrd.1986.134.3.488. PMID 3752705.
- ↑ 2.0 2.1 Laroche CM, Carroll N, Moxham J, Green M (October 1988). "Clinical significance of severe isolated diaphragm weakness". Am. Rev. Respir. Dis. 138 (4): 862–6. doi:10.1164/ajrccm/138.4.862. PMID 3202460.
- ↑ Mier-Jedrzejowicz A, Brophy C, Moxham J, Green M (April 1988). "Assessment of diaphragm weakness". Am. Rev. Respir. Dis. 137 (4): 877–83. doi:10.1164/ajrccm/137.4.877. PMID 3354995.
- ↑ Kumar N, Folger WN, Bolton CF (December 2004). "Dyspnea as the predominant manifestation of bilateral phrenic neuropathy". Mayo Clin. Proc. 79 (12): 1563–5. doi:10.4065/79.12.1563. PMID 15595343.
- ↑ Oruc O, Sarac S, Afsar GC, Topcuoglu OB, Kanbur S, Yalcinkaya I, Tepetam FM, Kirbas G (September 2016). "Is polysomnographic examination necessary for subjects with diaphragm pathologies?". Clinics (Sao Paulo). 71 (9): 506–10. doi:10.6061/clinics/2016(09)04. PMC 5004572. PMID 27652831.