Diaphragmatic paralysis diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
Studies of choice for unilateral diaphragmatic paralysis include upright chest radiograph and fluoroscopic sniff test. Studies of choice for bilateral diaphragmatic paralysis include measurement of transdiaphragmatic pressure (Pdi).


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
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** Bilateral diaphragmatic paralysis:
** Bilateral diaphragmatic paralysis:
*** Maximal transdiaphragmatic pressure is less than 40 cm water and it effects normal ventilatory behaviors.
*** Maximal transdiaphragmatic pressure is less than 40 cm water and it effects normal ventilatory behaviors.
==== The comparison table for diagnostic studies of choice for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
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*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].




Revision as of 17:22, 21 February 2018

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

Overview

Studies of choice for unilateral diaphragmatic paralysis include upright chest radiograph and fluoroscopic sniff test. Studies of choice for bilateral diaphragmatic paralysis include measurement of transdiaphragmatic pressure (Pdi).

Diagnostic Study of Choice

Study of choice:

Unilateral diaphragmatic paralysis

  • Fluoroscopic sniff test:
    • Observation of diaphragamtic movement when patient sniffs forcefully [3]
    • Paradoxical elevation of the paralyzed hemidiaphragm during inspiration[4]

Bilateral diaphragmatic paralysis

  • Measurement of transdiaphragmatic pressure (Pdi) is the gold standard test for the diagnosis of bilateral diaphragmatic paralysis.
    • This test is performed with two catheters. One of them is placed in esophagus and it assesses changing pleural pressure (Ppl) and another one is placed in stomach and it detects changing gastric pressure (Pga).
    • Pdi is the difference between Ppl and Pga (Pdi = Ppl – Pga).
    • Normal transdiaphragmatic pressure:[5]
      • Men: 148 cm water
      • Women: 122 cm water
  • The following result of transdiaphragmatic pressure (Pdi) is confirmatory of bilateral diaphragmatic paralysis:[6][7]
    • Unilateral diaphragmatic paralysis:
      • Maximal transdiaphragmatic pressure is more than 70 cm water and it does not effect normal ventilatory behaviors but it may compromise coughing or sneezing.
    • Bilateral diaphragmatic paralysis:
      • Maximal transdiaphragmatic pressure is less than 40 cm water and it effects normal ventilatory behaviors.


References

  1. ↑ Chetta A, Rehman AK, Moxham J, Carr DH, Polkey MI (January 2005). "Chest radiography cannot predict diaphragm function". Respir Med. 99 (1): 39–44. PMID 15672847.
  2. ↑ Gierada DS, Slone RM, Fleishman MJ (May 1998). "Imaging evaluation of the diaphragm". Chest Surg. Clin. N. Am. 8 (2): 237–80. PMID 9619304.
  3. ↑ Gierada DS, Slone RM, Fleishman MJ (May 1998). "Imaging evaluation of the diaphragm". Chest Surg. Clin. N. Am. 8 (2): 237–80. PMID 9619304.
  4. ↑ Alexander C (January 1966). "Diaphragm movements and the diagnosis of diaphragmatic paralysis". Clin Radiol. 17 (1): 79–83. PMID 4221861.
  5. ↑ Miller JM, Moxham J, Green M (July 1985). "The maximal sniff in the assessment of diaphragm function in man". Clin. Sci. 69 (1): 91–6. PMID 4064560.
  6. ↑ Gill LC, Mantilla CB, Sieck GC (May 2015). "Impact of unilateral denervation on transdiaphragmatic pressure". Respir Physiol Neurobiol. 210: 14–21. doi:10.1016/j.resp.2015.01.013. PMC 4449269. PMID 25641347.
  7. ↑ McCool FD, Tzelepis GE (March 2012). "Dysfunction of the diaphragm". N. Engl. J. Med. 366 (10): 932–42. doi:10.1056/NEJMra1007236. PMID 22397655.

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