Two-dimensional ultrasound imaging of the diaphragm: Quantitative values in normal subjects
Introduction: Real time ultrasound imaging of the diaphragm is an under‐used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. Methods: We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with resu...
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Published in | Muscle & nerve Vol. 47; no. 6; pp. 884 - 889 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Blackwell Publishing Ltd
01.06.2013
Wiley Subscription Services, Inc |
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Abstract | Introduction: Real time ultrasound imaging of the diaphragm is an under‐used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. Methods: We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history. Results: The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history. Conclusions: This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. Muscle Nerve 47: 884–889, 2013 |
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AbstractList | Introduction: Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. Methods: We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history. Results: The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history. Conclusions: This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. Muscle Nerve 47: 884-889, 2013 [PUBLICATION ABSTRACT] Introduction : Real time ultrasound imaging of the diaphragm is an under‐used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. Methods : We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history. Results : The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history. Conclusions : This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. Muscle Nerve 47: 884–889, 2013 Introduction: Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. Methods: We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history. Results: The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history. Conclusions: This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. Muscle Nerve 47: 884-889, 2013 Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure.INTRODUCTIONReal time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure.We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history.METHODSWe measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history.The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history.RESULTSThe lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history.This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population.CONCLUSIONSThis study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. We measured diaphragm thickness and the change in thickness that occurs with maximal inspiration in 150 normal subjects, with results stratified for age, gender, body mass index, and smoking history. The lower limit of normal diaphragm thickness at end expiration or functional residual capacity is 0.15 cm, and an increase of at least 20% in diaphragm thickness from functional residual capacity to total lung capacity is normal. A side to side difference in thickness at end expiration of > 0.33 cm is abnormal. Diaphragm thickness and contractility are minimally affected by age, gender, body habitus, or smoking history. This study confirms previous findings in much smaller groups of normal controls for quantitative ultrasound of the diaphragm and provides data that can be applied widely to the general population. |
Author | Sorenson, Eric J. Watson, James C. Strommen, Jeffrey A. Harper, Caitlin J. Boon, Andrea J. Ghahfarokhi, Leili Shahgholi |
Author_xml | – sequence: 1 givenname: Andrea J. surname: Boon fullname: Boon, Andrea J. email: boon.andrea@mayo.edu organization: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA – sequence: 2 givenname: Caitlin J. surname: Harper fullname: Harper, Caitlin J. organization: Mayo Medical School, Minnesota, Rochester, USA – sequence: 3 givenname: Leili Shahgholi surname: Ghahfarokhi fullname: Ghahfarokhi, Leili Shahgholi organization: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA – sequence: 4 givenname: Jeffrey A. surname: Strommen fullname: Strommen, Jeffrey A. organization: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA – sequence: 5 givenname: James C. surname: Watson fullname: Watson, James C. organization: Department of Neurology, Mayo Clinic, Minnesota, Rochester, USA – sequence: 6 givenname: Eric J. surname: Sorenson fullname: Sorenson, Eric J. organization: Department of Neurology, Mayo Clinic, Minnesota, Rochester, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23625789$$D View this record in MEDLINE/PubMed |
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References | O'Brien PC, Dyck PJ. Procedures for setting normal values. Neurology 1995;45:17-23. McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012;366:932-942. Urvoas E, Pariente D, Fausser C, Lipsich J, Taleb R, Devictor D. Diaphragmatic paralysis in children: diagnosis by TM-mode ultrasound. Pediatr Radiol 1994;24:564-568. Cohen WN. B-scan ultrasonography of abdominal mass lesions. Radiology 1969;93:589-591. Boon AJ, Alsharif KI, Harper CM, Smith J. Ultrasound-guided needle EMG of the diaphragm: technique description and case report. Muscle Nerve 2008;38:1623-1626. Harris RS, Giovannetti M, Kim BK. Normal ventilatory movement of the right hemidiaphragm studied by ultrasonography and pneumotachography. Radiology 1983;146:141-144. Houston JG, Morris AD, Howie CA, Reid JL, Mcmillan N. Technical report - quantitative assessment of diaphragmatic movement - a reproducible method using ultrasound. Clin Radiol 1992;46:405-407. Chavhan GB, Babyn PS, Cohen RA, Langer JC. Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics 2010;30:1797-1817. Resman-Gaspersc A, Podnar S. Phrenic nerve conduction studies: technical aspects and normative data. Muscle Nerve 2008;37:36-41. Cohn D, Benditt JO, Eveloff S, McCool FD. Diaphragm thickening during inspiration. J Appl Physiol 1997;83:291-296. Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008;133:737-743. Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20:597-604. Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997;155:1570-1574. Mccauley RGK, Labib KB. Diaphragmatic paralysis evaluated by phrenic-nerve stimulation during fluoroscopy or real-time ultrasound. Radiology 1984;153:33-36. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400. De Bruin PF, Ueki J, Bush A, Khan Y, Watson A, Pride NB. Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy. Thorax 1997;52:472-475. Wait JL, Nahormek PA, Yost WT, Rochester DP. Diaphragmatic thickness-lung volume relationship in vivo. J Appl Physiol 1989;67:1560-1568. Haber K, Asher WM, Freimanis AK. Echographic evaluation of diaphragmatic motion in intraabdominal diseases. Radiology 1975;114:141-144. Bolton CF, Grand'Maison F, Parkes A, Shkrum M. Needle electromyography of the diaphragm. Muscle Nerve 1992;15:678-681. Chen R, Collins S, Remtulla H, Parkes A, Bolton CF. Phrenic nerve conduction study in normal subjects. Muscle Nerve 1995;18:330-335. Houston JG, Morris AD, Howie CA, Reid JL, McMillan N. Technical report: quantitative assessment of diaphragmatic movement-a reproducible method using ultrasound. Clin Radiol 1992;46:405-407. Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 1995;50:1157-1161. Epelman M, Navarro OM, Daneman A, Miller SF. M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients. Pediatr Radiol 2005;35:661-667. Ayoub J, Cohendy R, Prioux J, Ahmaidi S, Bourgeois JM, Dauzat M, et al. Diaphragm movement before and after cholecystectomy: a sonographic study. Anesth Analg 2001;92:755-761. 2001; 92 1995; 50 1983; 146 1984; 153 1989; 67 1997; 83 2012; 366 1969; 93 1997; 52 1995; 45 2008; 38 1997; 155 2008; 37 2009; 135 1994; 24 1992; 46 1992; 15 1995; 18 2008; 133 1975; 114 2010; 30 2001; 20 2005; 35 e_1_2_7_6_1 e_1_2_7_5_1 e_1_2_7_4_1 e_1_2_7_3_1 e_1_2_7_9_1 e_1_2_7_8_1 e_1_2_7_7_1 e_1_2_7_19_1 e_1_2_7_18_1 e_1_2_7_17_1 e_1_2_7_16_1 e_1_2_7_2_1 e_1_2_7_15_1 e_1_2_7_14_1 e_1_2_7_25_1 e_1_2_7_13_1 e_1_2_7_24_1 e_1_2_7_12_1 e_1_2_7_23_1 e_1_2_7_11_1 e_1_2_7_22_1 e_1_2_7_10_1 Ayoub J (e_1_2_7_20_1) 2001; 92 e_1_2_7_21_1 |
References_xml | – reference: Ueki J, De Bruin PF, Pride NB. In vivo assessment of diaphragm contraction by ultrasound in normal subjects. Thorax 1995;50:1157-1161. – reference: Boon AJ, Alsharif KI, Harper CM, Smith J. Ultrasound-guided needle EMG of the diaphragm: technique description and case report. Muscle Nerve 2008;38:1623-1626. – reference: O'Brien PC, Dyck PJ. Procedures for setting normal values. Neurology 1995;45:17-23. – reference: Cohen WN. B-scan ultrasonography of abdominal mass lesions. Radiology 1969;93:589-591. – reference: Mccauley RGK, Labib KB. Diaphragmatic paralysis evaluated by phrenic-nerve stimulation during fluoroscopy or real-time ultrasound. Radiology 1984;153:33-36. – reference: Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Monitoring recovery from diaphragm paralysis with ultrasound. Chest 2008;133:737-743. – reference: De Bruin PF, Ueki J, Bush A, Khan Y, Watson A, Pride NB. Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy. Thorax 1997;52:472-475. – reference: Houston JG, Morris AD, Howie CA, Reid JL, McMillan N. Technical report: quantitative assessment of diaphragmatic movement-a reproducible method using ultrasound. Clin Radiol 1992;46:405-407. – reference: Chen R, Collins S, Remtulla H, Parkes A, Bolton CF. Phrenic nerve conduction study in normal subjects. Muscle Nerve 1995;18:330-335. – reference: Wait JL, Nahormek PA, Yost WT, Rochester DP. Diaphragmatic thickness-lung volume relationship in vivo. J Appl Physiol 1989;67:1560-1568. – reference: Houston JG, Morris AD, Howie CA, Reid JL, Mcmillan N. Technical report - quantitative assessment of diaphragmatic movement - a reproducible method using ultrasound. Clin Radiol 1992;46:405-407. – reference: Bolton CF, Grand'Maison F, Parkes A, Shkrum M. Needle electromyography of the diaphragm. Muscle Nerve 1992;15:678-681. – reference: Chavhan GB, Babyn PS, Cohen RA, Langer JC. Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics 2010;30:1797-1817. – reference: Resman-Gaspersc A, Podnar S. Phrenic nerve conduction studies: technical aspects and normative data. Muscle Nerve 2008;37:36-41. – reference: Harris RS, Giovannetti M, Kim BK. Normal ventilatory movement of the right hemidiaphragm studied by ultrasonography and pneumotachography. Radiology 1983;146:141-144. – reference: Haber K, Asher WM, Freimanis AK. Echographic evaluation of diaphragmatic motion in intraabdominal diseases. Radiology 1975;114:141-144. – reference: Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135:391-400. – reference: Ayoub J, Cohendy R, Prioux J, Ahmaidi S, Bourgeois JM, Dauzat M, et al. Diaphragm movement before and after cholecystectomy: a sonographic study. Anesth Analg 2001;92:755-761. – reference: Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20:597-604. – reference: Urvoas E, Pariente D, Fausser C, Lipsich J, Taleb R, Devictor D. Diaphragmatic paralysis in children: diagnosis by TM-mode ultrasound. Pediatr Radiol 1994;24:564-568. – reference: Epelman M, Navarro OM, Daneman A, Miller SF. M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients. Pediatr Radiol 2005;35:661-667. – reference: Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997;155:1570-1574. – reference: Cohn D, Benditt JO, Eveloff S, McCool FD. Diaphragm thickening during inspiration. J Appl Physiol 1997;83:291-296. – reference: McCool FD, Tzelepis GE. Dysfunction of the diaphragm. N Engl J Med 2012;366:932-942. – volume: 114 start-page: 141 year: 1975 end-page: 144 article-title: Echographic evaluation of diaphragmatic motion in intraabdominal diseases publication-title: Radiology – volume: 20 start-page: 597 year: 2001 end-page: 604 article-title: Ultrasonographic evaluation of diaphragmatic motion publication-title: J Ultrasound Med – volume: 366 start-page: 932 year: 2012 end-page: 942 article-title: Dysfunction of the diaphragm publication-title: N Engl J Med – volume: 50 start-page: 1157 year: 1995 end-page: 1161 article-title: In vivo assessment of diaphragm contraction by ultrasound in normal subjects publication-title: Thorax – volume: 67 start-page: 1560 year: 1989 end-page: 1568 article-title: Diaphragmatic thickness‐lung volume relationship in vivo publication-title: J Appl Physiol – volume: 153 start-page: 33 year: 1984 end-page: 36 article-title: Diaphragmatic paralysis evaluated by phrenic‐nerve stimulation during fluoroscopy or real‐time ultrasound publication-title: Radiology – volume: 35 start-page: 661 year: 2005 end-page: 667 article-title: M‐mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients publication-title: Pediatr Radiol – volume: 133 start-page: 737 year: 2008 end-page: 743 article-title: Monitoring recovery from diaphragm paralysis with ultrasound publication-title: Chest – volume: 92 start-page: 755 year: 2001 end-page: 761 article-title: Diaphragm movement before and after cholecystectomy: a sonographic study publication-title: Anesth Analg – volume: 83 start-page: 291 year: 1997 end-page: 296 article-title: Diaphragm thickening during inspiration publication-title: J Appl Physiol – volume: 46 start-page: 405 year: 1992 end-page: 407 article-title: Technical report: quantitative assessment of diaphragmatic movement–a reproducible method using ultrasound publication-title: Clin Radiol – volume: 37 start-page: 36 year: 2008 end-page: 41 article-title: Phrenic nerve conduction studies: technical aspects and normative data publication-title: Muscle Nerve – volume: 52 start-page: 472 year: 1997 end-page: 475 article-title: Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy publication-title: Thorax – volume: 30 start-page: 1797 year: 2010 end-page: 1817 article-title: Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions publication-title: Radiographics – volume: 155 start-page: 1570 year: 1997 end-page: 1574 article-title: Ultrasound evaluation of the paralyzed diaphragm publication-title: Am J Respir Crit Care Med – volume: 45 start-page: 17 year: 1995 end-page: 23 article-title: Procedures for setting normal values publication-title: Neurology – volume: 46 start-page: 405 year: 1992 end-page: 407 article-title: Technical report ‐ quantitative assessment of diaphragmatic movement ‐ a reproducible method using ultrasound publication-title: Clin Radiol – volume: 15 start-page: 678 year: 1992 end-page: 681 article-title: Needle electromyography of the diaphragm publication-title: Muscle Nerve – volume: 18 start-page: 330 year: 1995 end-page: 335 article-title: Phrenic nerve conduction study in normal subjects publication-title: Muscle Nerve – volume: 135 start-page: 391 year: 2009 end-page: 400 article-title: Diaphragmatic motion studied by m‐mode ultrasonography: methods, reproducibility, and normal values publication-title: Chest – volume: 93 start-page: 589 year: 1969 end-page: 591 article-title: B‐scan ultrasonography of abdominal mass lesions publication-title: Radiology – volume: 146 start-page: 141 year: 1983 end-page: 144 article-title: Normal ventilatory movement of the right hemidiaphragm studied by ultrasonography and pneumotachography publication-title: Radiology – volume: 38 start-page: 1623 year: 2008 end-page: 1626 article-title: Ultrasound‐guided needle EMG of the diaphragm: technique description and case report publication-title: Muscle Nerve – volume: 24 start-page: 564 year: 1994 end-page: 568 article-title: Diaphragmatic paralysis in children: diagnosis by TM‐mode ultrasound publication-title: Pediatr Radiol – ident: e_1_2_7_16_1 doi: 10.1378/chest.07-2200 – ident: e_1_2_7_4_1 doi: 10.1148/radiology.153.1.6473801 – ident: e_1_2_7_2_1 doi: 10.7863/jum.2001.20.6.597 – ident: e_1_2_7_25_1 doi: 10.1007/BF02012733 – ident: e_1_2_7_7_1 doi: 10.1007/s00247-005-1433-7 – volume: 92 start-page: 755 year: 2001 ident: e_1_2_7_20_1 article-title: Diaphragm movement before and after cholecystectomy: a sonographic study publication-title: Anesth Analg – ident: e_1_2_7_13_1 doi: 10.1056/NEJMra1007236 – ident: e_1_2_7_15_1 doi: 10.1164/ajrccm.155.5.9154859 – ident: e_1_2_7_11_1 doi: 10.1002/mus.20887 – ident: e_1_2_7_19_1 doi: 10.1378/chest.08-1541 – ident: e_1_2_7_6_1 doi: 10.1152/jappl.1989.67.4.1560 – ident: e_1_2_7_10_1 doi: 10.1002/mus.880180311 – ident: e_1_2_7_14_1 doi: 10.1136/thx.50.11.1157 – ident: e_1_2_7_5_1 doi: 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Snippet | Introduction: Real time ultrasound imaging of the diaphragm is an under‐used tool in the evaluation of patients with unexplained dyspnea or respiratory... Introduction : Real time ultrasound imaging of the diaphragm is an under‐used tool in the evaluation of patients with unexplained dyspnea or respiratory... Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory failure. We measured... Introduction: Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory... Real time ultrasound imaging of the diaphragm is an under-used tool in the evaluation of patients with unexplained dyspnea or respiratory... |
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SubjectTerms | Adult Age Aged Aged, 80 and over Body Mass Index diaphragm Diaphragm - diagnostic imaging Dyspnea - physiopathology Female Humans Male Medical research Middle Aged normal values Organ Size phrenic neuropathy quantitative ultrasound Reference Values Respiration Ultrasonic imaging Ultrasonography ultrasound Young Adult |
Title | Two-dimensional ultrasound imaging of the diaphragm: Quantitative values in normal subjects |
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