A diaphragmatic defect is not specific for a rupture. 22, No. Note the diaphragmatic slips that attach to the ribs (arrowheads).Download as PowerPointOpen in Image (b) Normal expiratory posteroanterior radiograph obtained at the same time shows that both hemidiaphragms have moved cranially by more than one rib interspace. Functional imaging with fluoroscopy (or US or MR imaging) is a simple and effective way to diagnose diaphragmatic dysfunction. Functional imaging with fluoroscopy (or ultrasonography or magnetic resonance imaging) is a simple and effective method of diagnosing diaphragmatic dysfunction, which … The lateral arcuate ligaments are thickened fascial bands covering the quadratus lumborum muscle and extend from the transverse processes of T12 laterally to the midportion of the 12th ribs. Management of Delayed Presentation of a Right-Side Traumatic Diaphragmatic Rupture, Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture, Multidetector computed tomography of diaphragm: Anatomic variants and diagnostic problems in adult population, Isolated right diaphragmatic rupture following blunt trauma, Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases, Chest Trauma in Children: Current Imaging Guidelines and Techniques, Current Use of CT in the Evaluation and Management of Injured Patients, Multimodality Imaging of the Pediatric Diaphragm: Anatomy and Pathologic Conditions1, Hernia diafragmática diferida en paciente sometido a ventilación mecánica, Traumatic diaphragmatic hernia masquerading as leftsided hydropneumothorax: a case report, A case of delayed diagnosis of a right-sided diaphragm rupture with a review of the literature, Diaphragmatic rupture during labour, two years after an intra-oesophageal rupture of a bronchogenic cyst treated by an omental wrapping, The imaging of paediatric thoracic trauma, Atypical abdominal hernias in the emergency department: acute and non-acute, Percutaneous Radiofrequency Ablation for the Hepatocellular Carcinoma Abutting the Diaphragm: Assessment of Safety and Therapeutic Efficacy, Traumatismes abdominaux : les lésions élémentaires, Penetrating rupture of the diaphragm without visceral herniation: MDCT diagnosis, Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients, Massive hemoperitoneum due to ruptured inferior phrenic artery pseudoaneurysm after blunt trauma, Emergency chest radiology: chest wall, pleura, lungs and diaphragm, Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion, Imaging of diaphragmatic rupture after trauma, Traumatic diaphragmatic hernias: Retrospective analysis, Hérnias diafragmáticas traumáticas: Revisão casuística, Traumatic, pericardio-diaphragmatic rupture: An extremely rare cause of pericarditis, Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases, Sonographic appearance of a late-diagnosed left bochdalek hernia in a middle-aged woman: Case report and review of the literature, Computed tomography without oral contrast solution for blunt diaphragmatic injuries in abdominal trauma, Rupture diaphragmatique droite découverte à la suite d’un traumatisme, Helical CT of Blunt Diaphragmatic Rupture. However, we include the upper chest so that we can observe the motion of the anterior chest wall. Diagnostic ultrasound and lately ultrafast magnetic resonance imaging (MRI) play a major role in the detection of fetal intrathoracic pathology. 39, No. Diaphragmatic elevation due to normal exhalation. The two diaphragmatic crura attach the diaphragm posteriorly to the upper lumbar vertebral bodies and disks. (a, b) CT scan (a) and sagittal reformatted image (b) show an isolated elevation of the diaphragm (arrow) without discontinuity. 40, No. Plication and phrenic nerve stimulation are options. After placement of the stimulators, the patient was successfully weaned from daytime mechanical ventilation.Figure 27Download as PowerPointOpen in Image Coronal (a) and sagittal (b) CT reformatted images show an apparent isolated liver herniation due to motion artifact, which could mimic a diaphragmatic tear. 23, No. 2, Japanese Journal of Radiology, Vol. As described by Gale (,4), the diaphragm characteristically assumes one of three appearances anteriorly, depending on the cephalocaudal relationship between the xiphoid and the middle leaflets of the central diaphragmatic tendon. If the patient undergoes fluoroscopy to explain ventilator dependence, we observe the motion of the diaphragm with the ventilator attached and then work with the respiratory therapist to briefly disconnect the ventilator and record a few spontaneous deep breaths before resuming mechanical ventilation. Note the right-sided rib fracture on the scan (a). 45, No. This sign requires careful analysis of axial images and sagittal and coronal multiplanar reformatted images. Drawing shows radial (A), transverse (B), and central (C) ruptures and a peripheral detachment (D). (a) CT scan obtained at the level of the hepatic hilum shows a defect in the continuity of the anterolateral left hemidiaphragm (arrows). The hemidiaphragms are well demonstrated when they are marginated by peritoneal, retroperitoneal, or extraperitoneal fat (top arrow).Download as PowerPointOpen in Image 13, No. Diaphragmatic defects in a 68-year-old patient. 45, No. 13, No. 26, No. Diaphragmatic attachments. 6, No. 63, No. The thinned and flaccid muscle and central tendon are gathered in pleats and sutured, lowering and tightening the hemidiaphragm and increasing intrathoracic volume (Fig 24). Left diaphragmatic tear in a 65-year-old patient after blunt trauma. (c) CT scan shows the type 3 configuration. 2, 1 January 2016 | Journal of Ultrasound in Medicine, Vol. (b) CT scan shows the type 2 configuration. Viewer. The normal diaphragm appears as a continuous hypointense band with both sequences due to its muscular and fibrous nature (,,,,,Fig 15) (,23,,24). 1, Journal of the American College of Radiology, Vol. Figure 11a. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115127/-/DC1. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. The anterior muscle fibers lie anteriorly within a single plane. (d) Coronal contrast-enhanced fast gradient-echo MR image clearly shows waistlike constriction of the liver at the level of the diaphragmatic tear.Download as PowerPointOpen in Image In addition, increased acquisition speed significantly improves the management of polytraumatized patients and allows detection of frequent additional injuries. Large Morgagni hernia involving the anterior right hemidiaphragm. (a) CT scan obtained at the level of the hepatic hilum shows a defect in the continuity of the anterolateral left hemidiaphragm (arrows). Figure 5b. Thus, reformation images are of better quality and can be helpful in detecting subtle visceral herniations, especially in patients with right-sided injuries. 2, 17 January 2009 | Pediatric Radiology, Vol. These defects occur more commonly on the left side and are thought to represent congenital asymptomatic Bochdalek hernias. Coronal CT image shows thinning and elevation of both hemidiaphragms, findings that are more easily appreciated on the left (arrow).Figure 11Download as PowerPointOpen in Image Other financial activities: consultant for Snohomish County, Washington, and for attorneys; reviewer for Autopsy: Healthwise. 110, No. Coronal (a) and sagittal (b) CT reformatted images show an apparent isolated liver herniation due to motion artifact, which could mimic a diaphragmatic tear.Download as PowerPointOpen in Image According to the literature, initial radiographs allow diagnosis of 27%–60% of left-sided injuries but only 17% of right-sided injuries (,14). 5, Texas Heart Institute Journal, Vol. Normal hemidiaphragms move inferiorly with inhalation. Viewer. Viewer. Again, if the patient is supine, excursion of the diaphragm is reduced by the weight of the abdomen. 8, 17 February 2015 | Physiotherapy Research International, Vol. 24, No. Viewer. Functional imaging with fluoroscopy (or ultrasonography or magnetic resonance imaging) is a simple and effective method of diagnosing diaphragmatic dysfunction, which can be classified as paralysis, weakness, or eventration. Central nervous system causes of diaphragmatic dysfunction include cervical spine trauma (17) and degeneration (18). 55, No. Explain the fluoroscopic sniff test and list imaging findings suggestive of diaphragmatic dysfunction. 2, The Korean Journal of Physical Education, Vol. However, concurrent pulmonary abnormalities related to the trauma such as pleural effusion, pulmonary contusion or laceration, atelectasis, and phrenic nerve palsy can mimic or mask diaphragmatic injury on chest radiographs. Consequently, it is well suited to evaluation of the diaphragm and improves the accuracy of CT in diagnosis of diaphragmatic injuries (,20,,21). 9, Asian Cardiovascular and Thoracic Annals, Vol. Thoracic injuries such as pneumohemothoraces and rib fractures are seen in 90% of patients (,2). (a) Helical CT scan (direct axial section) shows a focal indentation at the posterolateral aspect of the liver (arrow), a finding suggestive of a right diaphragmatic tear. ], a pediatric intensivist who was trained by the pediatric radiologist in repeated training sessions over 1 year on abdominal sonography and assessment of diaphragmatic excursion and thickness in infants and children and … (a) Drawing shows the paired phrenic nerves (yellow), which originate from spinal nerves C3–C5 and travel through the neck and mediastinum to reach the diaphragm, where they arborize on the superior and inferior surfaces. Movement of the diaphragm can be evaluated with diagnostic ultrasound using B- and M-mode techniques. CT scans (direct axial sections) show diaphragmatic defects (arrow) of the right (a) and left (b) posterolateral hemidiaphragms. (b, c) Drawings (view from above [b] and frontal view [c]) show initial placement of sutures buttressed by Teflon pledgets, thus forming pleats in the hemidiaphragm. Coronal (a) and axial (b) CT images show the right lateral arcuate ligament (arrow) coursing to the 12th rib. 5, Egyptian Journal of Bronchology, Vol. Lung volumes have decreased with new basal atelectasis. Due to portability and capability of imaging without ionizing radiation, ultrasound has become the preferred imaging modality for the evaluation of diaphragmatic motion in children. 3, 17 February 2007 | European Radiology, Vol. Left diaphragmatic tear in a 65-year-old patient after blunt trauma. Anatomically, the diaphragm is composed of two parts: the lumbar diaphragm and costal diaphragm (,3). (a) Posteroanterior radiograph shows an appearance that was initially interpreted as elevation of the right hemidiaphragm. The diaphragm is the primary muscle of ventilation. 27, No. The tubular esophagus extends to just above the diaphragm. Over the last 15 years, certain indices of diaphragm function, namely diaphragm thickness, thickening fraction and excursion have been established for mechanically ventilated patients to track changes in diaphragm size and function over time, to assess and diagnose diaphragmatic dysfunction, and to evaluate if these … The frontal X-ray may show a 'double' diaphragmatic contour, which is easily confirmed on the lateral projection. Treatment of diaphragmatic paralysis depends on the cause of the dysfunction and the severity of the symptoms. In this case, excursion of the affected segment is reduced on quiet and deep inspiration and may be paradoxical on sniffing (see also Movie 10). (a) CT image shows the location of the IVC hiatus, which is at the T8 level and contains the IVC (arrow) and branches of the right phrenic nerve (not visible). 12, 1 December 2013 | Academic Forensic Pathology, Vol. 11, No. 156, No. Normal anatomy of the diaphragm. Bochdalek hernia is typically left sided and results from a developmental defect of the pleuroperitoneal folds or failure of fusion of the folds and transverse septum with the intercostal muscles. Other financial activities: none. We center the x-ray beam at the level of the diaphragm and collimate from the sides. Right diaphragmatic tear in a 46-year-old man who experienced multiple injuries in a motor vehicle accident. C.M.W. 30, No. 5, 2 August 2008 | Emergency Radiology, Vol. Diaphragm Mark C. Liszewski Evan J. Zucker Bernard F. Laya Ricardo Restrepo Edward Y. Lee INTRODUCTION The diaphragm is a large, flat, and dome-shaped musculotendinous structure that separates the thoracic and abdominal cavities, and is the primary muscle that drives respiration. Figure 15d. Three large openings disrupt the continuity of the diaphragm: the aortic, esophageal, and inferior vena caval apertures. Figure 10c. Further ruptures of the diaphragm can occur in its central portion and at the costal attachment spreading in a transverse direction. ICU, intensive care unit. The diaphragm is the primary muscle of ventilation. Each method of imaging evaluation has advantages and pitfalls according to the type of diaphragmatic rupture. (a) Helical CT scan (direct axial section) shows a focal indentation at the posterolateral aspect of the liver (arrow), a finding suggestive of a right diaphragmatic tear. Dependent viscera sign in a 28-year-old pregnant woman after a motor vehicle accident. (e) Image from laparoscopy shows the intrathoracic herniation of the stomach and the diaphragmatic tear.Download as PowerPointOpen in Image Figure 15c. Clinical features are highly variable according to underlying etiological factor: 1. unilateral paralysis: asymptomatic in most of the patients as the other lung compensates 1.1. may have dyspnea, headaches, fatigue, insomnia and overall breathing difficulty 2. bilateral diaphragmatic palsy can be a medical emergency; they present with severe dyspnea, even with mild exertion This distention is best demonstrated by breath holding in inspiration or a Valsalva maneuver. 116, No. Previous studies suggested that conventional CT offered limited accuracy in revealing diaphragmatic injury. Penetrating injuries such as gunshot wounds or stab injuries are more random (2:1 ratio of penetrating vs blunt trauma) and produce small diaphragmatic holes (usually <1 cm in diameter), which are often overlooked (,11). Right diaphragmatic tear in a 46-year-old man who experienced multiple injuries in a motor vehicle accident. (b) CT scan of the midthoracic region shows intrathoracic herniation of the stomach. (a) CT scan obtained at the level of the hepatic hilum shows a defect in the continuity of the anterolateral left hemidiaphragm (arrows). Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. In the type 2 configuration (28% of cases in the study by Gale [,4]), axial CT shows anterior divergence and apparent discontinuity of muscle fibers as they insert on costal cartilage. 20, No. Note the lack of hemidiaphragm at the focal defect. Figure 3. Viewer. The diaphragm is a fundamental muscle of the respiratory system. The left diaphragmatic crus (arrowhead) is also visible. The constricting rim of the diaphragm is seen as a low-signal-intensity structure around the herniated liver (arrowheads).Download as PowerPointOpen in Image 3, International Journal of Osteopathic Medicine, Vol. (c) Sagittal CT image shows the muscle bundles near the diaphragmatic dome (arrows). Motion artifact in a 28-year-old woman who was involved in a motor vehicle accident. This opening enlarges with inspiration, drawing blood into the heart. 8, The American Journal of Emergency Medicine, Vol. It also shows the motion of the sternum and anterior chest wall. 64, No. The constricting rim of the diaphragm is seen as a low-signal-intensity structure around the herniated liver (arrowheads). Existing methods focus on movement at a single point at the hemidiaphragm and may not consider the anatomic and functional complexity. 1, 2 August 2018 | BMC Pulmonary Medicine, Vol. Most renal masses are incidental findings. MR imaging can provide direct coronal and sagittal images, which are well suited for optimal visualization of the entire hemidiaphragm when motion is limited by respiratory and cardiac gating. We do not normally include lateral fluoroscopy if the patient cannot stand or sit. 3, 25 July 2016 | BMC Anesthesiology, Vol. 25, No. Ultrasonic scanning is a highly sensitive method of demonstrating generalized or localized abnormalities of diaphragmatic motion and is superior to fluoroscopy in several respects. Viewer. Pulmonary function tests show a restrictive pattern, which manifests as a reduction in forced vital capacity and forced expiratory volume in 1 second (14). 1, 9 August 2015 | Pediatric Radiology, Vol. 6, 29 November 2006 | Emergency Radiology, Vol. Diaphragmatic defects in a 68-year-old patient. In contrast to unilateral impairment, bilateral diaphragmatic dysfunction is usually symptomatic and may lead to ventilatory failure (13). 29, No. After placement of the stimulators, the patient was successfully weaned from daytime mechanical ventilation. Left diaphragmatic tear in a 24-year-old woman who was injured in a motor vehicle accident. Note the right-sided rib fracture on the scan (a). Eventration of the hemidiaphragm is a special case of weakness in which only a segment of the hemidiaphragm (typically the anterior aspect on the right) moves abnormally. (a) Initial radiograph shows elevation of the right hemidiaphragm owing to a phrenic nerve injury caused by cardiac surgery. 9, No. Diaphragmatic hiatuses. Figure 13b. The ventilatory movement of the right dome of the diaphragm was studied over the range of the inspiratory capacity in 50 healthy adults in the supine position using simultaneous ultrasonography and pneumotachography. 39, No. 1, Current Problems in Diagnostic Radiology, Vol. Viewer. Figure 12a. On deep inspiration, normal excursion is at least one rib interspace in adults. However, this sign is rarely isolated but represents an early indication of diaphragmatic tear on axial images before visceral herniation can be confidently diagnosed by using sagittal and coronal multiplanar reformation. Radiology department of the Onze Lieve Vrouwe Gasthuis in Amsterdam, Medical Center Haaglanden-Bronovo in the Hague, Leiden University Medical Center in Leiden and the Alrijne hospital in Leiderdorp, the Netherlands . 1, Journal of Cardiothoracic Surgery, Vol. 8, No. 2, 18 February 2015 | Case Reports, Vol. (e) Coronal CT image in a patient with ascites shows exaggerated eventration of the right hemidiaphragm with an undercut edge (mushroom appearance) (arrow). (e) Image from laparoscopy shows the intrathoracic herniation of the stomach and the diaphragmatic tear. (a) CT scan shows the type 1 configuration. Dysfunction of the diaphragm is an underappreciated cause of respiratory difficulties and may be due to a wide variety of entities, including surgery, trauma, tumor, and infection. Nevertheless, detection of diaphragmatic injuries has improved with helical CT and should further improve with multisection CT. Two major factors are mainly responsible for this improvement. Ultrasonic guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real time ultrasound visualization of vascular needle entry, with permanent recording and reporting; Additional CPT … Multisection CT with increased acquisition speed and higher in-plane and longitudinal spatial resolution may further improve the detection of diaphragmatic tears. (a) CT scan obtained at the level of the hepatic hilum shows a defect in the continuity of the anterolateral left hemidiaphragm (arrows). 30, No. The right hemidiaphragm moved in the superior direction during inspiration, a finding indicative of paradoxical motion. Left diaphragmatic tear in a 65-year-old patient after blunt trauma. In addition, the kidneys lie at an oblique angle, that is the superior renal pole is more medial and posteriorly than the inferior pole. When a patient with a ruptured diaphragm lies supine at CT examination, the herniated viscera (bowel or solid organs) are no longer supported posteriorly by the injured diaphragm and fall to a dependent position against the posterior ribs (,,,Fig 13). Despite its importance, the diaphragm is often underappreciated and incompletely evaluated by clinicians and radiologists.In this article, we review the embryology, anatomy, and function of the diaphragm and outli… 4, © 2021 Radiological Society of North America, Imaging of congenital diaphragmatic hernias, Morgagni hernia: a rare form of congenital diaphragmatic hernia, Computed tomography of retrocrural spaces: normal, anatomic variants, and pathologic conditions, A clinicoanatomical study of the arcuate ligament of the diaphragm, Median arcuate ligament syndrome: evaluation with CT angiography, The diaphragm: anatomic, pathologic, and radiologic considerations, Lateral arcuate ligaments of the diaphragm: anatomic variations at abdominal CT, The anterior diaphragmatic attachments: an anatomic and radiologic study with clinical correlates, Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions, Anatomic variations and abnormalities in the diaphragm seen with US, Analysis of lung volume restriction in patients with respiratory muscle weakness, Bilateral diaphragm paralysis: a challenging diagnosis, Unilateral diaphragmatic paralysis in spinal cord injury patients, Diaphragmatic paralysis caused by cervical spondylosis: case report, Phrenic nerve conduction in amyotrophic lateral sclerosis, Late onset respiratory failure in patients with previous poliomyelitis, Bilateral diaphragmatic paralysis and related respiratory complications in a patient with West Nile virus infection, Diaphragmatic dysfunction after heart or lung transplantation, Phrenic nerve dysfunction after cardiac operations: electrophysiologic evaluation of risk factors, Time course of recovery from frostbitten phrenics after coronary artery bypass graft surgery. (b) CT scan of the midthoracic region shows intrathoracic herniation of the stomach. S = stomach. Diaphragmatic paralysis and weakness may be temporary or permanent, depending on the cause. Although not yet widely used in practice, performance of dynamic MR imaging for evaluation of diaphragmatic function has also been described (39–41). Diaphragmatic defects in a 68-year-old patient. 98, No. (b) Posteroanterior radiograph shows a scalloped contour of the diaphragm caused by the slips (arrows) at their insertions on anterior ribs. Left diaphragmatic tear in a 65-year-old patient after blunt trauma. Figure 5c. In patients with pleural thickening, the diaphragm may become tethered to the chest wall, causing elevation and an abnormal diaphragmatic contour (Fig 21). 32, No. Note the right-sided rib fracture on the scan (a). C = colon. Figure 6. (c) Coronal contrast material-enhanced fat-suppressed fast gradient-echo MR image shows a high position of the liver in the thoracic cavity. Figure 5b. 184, No. The anterior muscle fibers appear to be oriented at an angle in relation to the lateral fibers with midline discontinuity (arrowhead). In addition, numerous patients with liver and splenic injuries are being treated conservatively without immediate surgery. 51, No. At CT, the medial muscle band formed the sharp edge of an eventration. (b) Sagittal T2-weighted MR image shows abnormal high signal intensity involving the dorsal columns (arrows). The anatomic location, its close relationship to adjacent intrathoracic and intraabdominal organs, and the severity of the trauma account for associated injuries in 52%–100% of patients with diaphragmatic tears (,2). The aortic hiatus is at the T12 level and contains the aorta, thoracic duct, and azygos and hemiazygos veins (Fig 10c). 37, No. Viewer. Note the dependent viscera sign. Isolated elevation of the diaphragm in a 59-year-old man after blunt trauma. Thus, the ability to detect diaphragmatic injuries with noninvasive techniques is increasingly important. Figure 14 Diaphragmatic paralysis caused by invasion of the phrenic nerve by non–small cell lung carcinoma. 17, No. Diaphragmatic weakness is indicated by reduced or delayed orthograde excursion on deep breathing, with or without paradoxical motion on sniffing. Definition of continuous diaphragm sign of pneumomediastinum: Continuous diaphragm sign is seen when The entire diaphragm is visualized from one side to the other because air in the mediastinum outlines the central portion which is usually obscured by the heart and mediastinal soft tissue structures that are in contact with the diaphragm. 3, Radiologic Clinics of North America, Vol. Solid blue line indicates diaphragm thickness. Although the diagnosis may be obvious at standard chest radiography or computed tomography (CT) in most situations, some more subtle signs require careful analysis of CT images and examination with magnetic resonance (MR) imaging in some specific situations. Gradient-echo sequences are faster; however, circumferential chemical shift artifact may prevent accurate evaluation by mimicking an intact diaphragm. (a, b) Posteroanterior (a) and lateral (b) radiographs show focal anterior elevation of the right and left hemidiaphragms (arrows). Its dysfunction is a frequent contributor to dyspnea. Viewer. 38, No. (a, b) CT scan (a) and sagittal reformatted image (b) show an isolated elevation of the diaphragm (arrow) without discontinuity. Isolated elevation of the diaphragm in a 59-year-old man after blunt trauma. (a) CT scan shows the type 1 configuration. 3, 24 July 2020 | RadioGraphics, Vol. Eventration can become more pronounced with increasing intraabdominal pressure, usually as a result of abdominal obesity (Fig 18). suppl_1, © 2021 Radiological Society of North America, MEDIASTINUM, CHEST WALL, AND DIAPHRAGM - Continuing Medical Education, https://doi.org/10.1148/radiographics.22.suppl_1.g02oc14s103, Open in Image 88, 13 February 2018 | Diseases, Vol. This modality also has the advantage of no ionizing radiation, but use of MR imaging for functional imaging of the diaphragm is largely limited by high costs. Note the right-sided rib fracture on the scan (a). 2, 1 June 2018 | Fisioterapia e Pesquisa, Vol. (c) CT image shows the aortic hiatus, which is at the T12 level and contains the aorta (black arrow), thoracic duct, and hemiazygos and azygos veins. The soft tissue-air interface at the level of the diaphragm causes near-complete sound reflection back into the liver. IVC = aperture for the inferior vena cava.Download as PowerPointOpen in Image The diaphragm is the primary muscle of ventilation. 3, No. CT scan shows the left arcuate ligament in the direct axial plane (arrowhead). 34, No. Injuries to the left hemidiaphragm occur three times more frequently than injuries to the right side following blunt trauma, possibly due to a buffering effect of the liver on the right hemidiaphragm (,7). Lung and diaphragm ultrasound methods have recently been introduced to predict the outcome of weaning from mechanical ventilation (MV). They are reported in 2%–6% of patients with diaphragmatic injury (,2). Drawing shows the central tendon (arrow) and the crura (arrowheads). 4, European Journal of Radiology Extra, Vol. 30, No. Right diaphragmatic tear in a 35-year-old man after a motor vehicle accident. (c) Sagittal single-shot fast spin-echo MR image clearly shows the posterior diaphragm (arrow), which is outlined by hemoperitoneum and pleural effusion. C = colon. (a) Normal inspiratory posteroanterior radiograph shows a minimal height difference between the hemidiaphragms. 25, No. Most often, we use the fluoroscopic sniff test to evaluate function of the diaphragm. (c, d) Sagittal (c) and coronal (d) reformatted images show the intrathoracic herniation of the stomach more clearly. These findings are consistent with paralysis of the right hemidiaphragm. 6, Canadian Association of Radiologists Journal, Vol. (a) CT scan shows the type 1 configuration. Figure 12d. 49, No. 1, Veterinary Radiology & Ultrasound, Vol. Imaging strategies are also discussed. Diaphragmatic paresis: pathophysiology, clinical features, and investigation, Hemidiaphragmatic paresis after cervical herpes zoster, Diaphragmatic paralysis and respiratory failure as a complication of Lyme disease, Significance of phrenic nerve electrophysiological abnormalities in Guillain-Barré syndrome, Phrenic neuropathy in association with diabetes, Bilateral diaphragmatic weakness: a late complication of radiotherapy, Overview of neuromuscular disorders affecting respiratory function, Differentiating diaphragmatic paralysis and eventration, Infrapulmonary pleural effusion simulating elevation of the hemidiaphragm, Diaphragm movements and the diagnosis of diaphragmatic paralysis, Ultrasonographic evaluation of diaphragmatic motion, M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients, Diaphragmatic paralysis: the use of M mode ultrasound for diagnosis in adults, Diaphragmatic motion: fast gradient-recalled-echo MR imaging in healthy subjects, Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease, Quantitative analysis of the velocity and synchronicity of diaphragmatic motion: dynamic MRI in different postures, Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients, Diaphragm plication for eventration or paralysis: a review of the literature, Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: an objective evaluation of short-term and midterm results, Long term results of diaphragmatic plication for unilateral diaphragm paralysis, Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea, Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis, Phrenic nerve stimulation in patients with spinal cord injury, http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115127/-/DC1, Open in Image
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