Diaphragmatic paralysis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Diagnostic Study of Choice
Template statements
Study of choice:
Unilateral diaphragmatic paralysis
- Fontal upright chest radiograph:
- Elevated hemidiaphragm in paralysed side[1]
- Chest xray is then confirmed with fluoroscopic sniff test
- Fluoroscopic sniff test:
In contrast to bilateral diaphragmatic paralysis, the diagnosis of unilateral paralysis is usually suggested by typical findings on the upright chest radiograph and confirmed by fluoroscopic evaluation. Pulmonary function testing provides supportive evidence of inspiratory muscle weakness, a measure of the degree of respiratory impairment, and a benchmark for future comparisons. The differential diagnosis of unilateral diaphragmatic paralysis includes a subpulmonic pleural effusion, diaphragmatic eventration, diaphragmatic hernia, and unilateral subdiaphragmatic processes (eg, abscess, splenomegaly).
, in which diaphragmatic movement is observed fluoroscopically while the patient sniffs forcefully [18]. The sniff test shows paradoxical elevation of the paralyzed hemidiaphragm with inspiration compared with the rapid descent of the normal hemidiaphragm. The sniff test is positive in over 90 percent of patients [19].
The sniff test shows paradoxical elevation of the paralyzed hemidiaphragm with inspiration compared with the rapid descent of the normal hemidiaphragm. The sniff test is positive in over 90 percent of patients [19].
- [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
- The following result of [gold standard test] is confirmatory of [disease name]:
- Result 1
- Result 2
- The [name of the investigation] should be performed when:
- The patient presented with symptoms/signs 1. 2, 3.
- A positive [test] is detected in the patient.
- [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
- The diagnostic study of choice for [disease name] is [name of the investigation].
- There is no single diagnostic study of choice for the diagnosis of [disease name].
- There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
- [Disease name] is mainly diagnosed based on clinical presentation.
- Investigations:
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
- Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
The comparison table for diagnostic studies of choice for [disease name]
| Sensitivity | Specificity | |
|---|---|---|
| Test 1 | ✔ | ...% |
| Test 2 | ...% | ✔ |
✔= The best test based on the feature
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.
- Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
- Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
- Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
- 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 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].
References
- ↑ 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.
- ↑ Gierada DS, Slone RM, Fleishman MJ (May 1998). "Imaging evaluation of the diaphragm". Chest Surg. Clin. N. Am. 8 (2): 237–80. PMID 9619304.
- ↑ Alexander C (January 1966). "Diaphragm movements and the diagnosis of diaphragmatic paralysis". Clin Radiol. 17 (1): 79–83. PMID 4221861.