Diaphragmatic paralysis other diagnostic studies: Difference between revisions

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==== 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:<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>  
** Unilateral diaphragmatic paralysis:  
*** Mild decrease in vital capacity (VC): 75% of the predicted value  and further decrease (10% to 20% in the supine position)
*** Mild decrease in vital capacity (VC): 75% of the predicted value  and further decrease (10% to 20% in the supine position) <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>
*** Functional residual capacity (FRC) and total lung capacity (TLC) are usually unchanged.  
*** Functional residual capacity (FRC) and total lung capacity (TLC) are usually unchanged. <ref name="pmid37527052">{{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>
** Bilateral diaphragmatic paralysis:  
** Bilateral diaphragmatic paralysis:  
*** 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>
*** 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>
Line 29: Line 29:
* MIP < −80 cmH2O exclude diaphragmatic paralysis <ref name="pmid27803970">{{cite journal |vauthors=Koo P, Oyieng'o DO, Gartman EJ, Sethi JM, Eaton CB, McCool FD |title=The Maximal Expiratory-to-Inspiratory Pressure Ratio and Supine Vital Capacity as Screening Tests for Diaphragm Dysfunction |journal=Lung |volume=195 |issue=1 |pages=29–35 |date=February 2017 |pmid=27803970 |doi=10.1007/s00408-016-9959-z |url= |author=}}</ref>
* MIP < −80 cmH2O exclude diaphragmatic paralysis <ref name="pmid27803970">{{cite journal |vauthors=Koo P, Oyieng'o DO, Gartman EJ, Sethi JM, Eaton CB, McCool FD |title=The Maximal Expiratory-to-Inspiratory Pressure Ratio and Supine Vital Capacity as Screening Tests for Diaphragm Dysfunction |journal=Lung |volume=195 |issue=1 |pages=29–35 |date=February 2017 |pmid=27803970 |doi=10.1007/s00408-016-9959-z |url= |author=}}</ref>
* MIP can be decreased:
* MIP can be decreased:
** Less than 60% of the predicted value in unilateral diaphragmatic paralysis<ref name="pmid3202460" />
** Less than 60% of the predicted value in unilateral diaphragmatic paralysis<ref name="pmid3261460">{{cite journal |vauthors=Laroche CM, Mier AK, Moxham J, Green M |title=Diaphragm strength in patients with recent hemidiaphragm paralysis |journal=Thorax |volume=43 |issue=3 |pages=170–4 |date=March 1988 |pmid=3261460 |pmc=461156 |doi= |url= |author=}}</ref>
** Less than 30% of the predicted value in bilateral diaphragmatic paralysis
** Less than 30% of the predicted value in bilateral diaphragmatic paralysis<ref name="pmid32024602">{{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>


* Maximal expiratory pressure (MEP) is normal.
* Maximal expiratory pressure (MEP) is normal.

Revision as of 15:53, 21 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

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:
      • Mild decrease in vital capacity (VC): 75% of the predicted value and further decrease (10% to 20% in the supine position) [1]
      • Functional residual capacity (FRC) and total lung capacity (TLC) are usually unchanged. [2]
    • Bilateral diaphragmatic paralysis:
      • Decrease in vital capacity (VC): 50 % of the predicted value and further decrease (30% to 50% in the supine position )[3]
      • Total lung capacity may be reduced
        • Residual volume (RV) may be elevated[4]

Maximal inspiratory pressure (MIP) :

  • MIP < −80 cmH2O exclude diaphragmatic paralysis [5]
  • MIP can be decreased:
    • Less than 60% of the predicted value in unilateral diaphragmatic paralysis[6]
    • Less than 30% of the predicted value in bilateral diaphragmatic paralysis[7]
  • Maximal expiratory pressure (MEP) is normal.
  • MEP/MIP >2 is supportive of thediagnosis 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 eyiology. [8]
  • Absence of an EMG signal is seen in complete transection of the phrenic nerves
  • [Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include:
    • [Finding 1]
    • [Finding 2]
    • [Finding 3]
  • Other diagnostic studies for [disease name] include:
    • [Diagnostic study 1], which demonstrates:
      • [Finding 1]
      • [Finding 2]
      • [Finding 3]
    • [Diagnostic study 2], which demonstrates:
      • [Finding 1]
      • [Finding 2]
      • [Finding 3]

References

  1. ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Koo P, Oyieng'o DO, Gartman EJ, Sethi JM, Eaton CB, McCool FD (February 2017). "The Maximal Expiratory-to-Inspiratory Pressure Ratio and Supine Vital Capacity as Screening Tests for Diaphragm Dysfunction". Lung. 195 (1): 29–35. doi:10.1007/s00408-016-9959-z. PMID 27803970.
  6. ↑ Laroche CM, Mier AK, Moxham J, Green M (March 1988). "Diaphragm strength in patients with recent hemidiaphragm paralysis". Thorax. 43 (3): 170–4. PMC 461156. PMID 3261460.
  7. ↑ 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.
  8. ↑ 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.

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