Chest ACCP Career Connection
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Suwatanapongched, T.
Right arrow Articles by Tuteur, P. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Suwatanapongched, T.
Right arrow Articles by Tuteur, P. G.
(Chest. 2003;123:2019-2027.)
© 2003 American College of Chest Physicians

Variation in Diaphragm Position and Shape in Adults With Normal Pulmonary Function*

Thitiporn Suwatanapongched, MD{dagger}; David S. Gierada, MD; Richard M. Slone, MD, FCCP{ddagger}; Thomas K. Pilgram, PhD and Peter G. Tuteur, MD, FCCP

* From Mallinckrodt Institute of Radiology (Drs. Suwatanapongched, Gierada, Slone, and Pilgram) and Division of Pulmonary and Critical Care Medicine (Dr. Tuteur), Washington University School of Medicine, St. Louis, MO. {dagger} Current affiliation is Division of Diagnostic Radiology, Depart-ment of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. {ddagger} Current affiliation is Celestial Imaging, PA, Mease Countryside Hospital, Safety Harbor, FL.

Correspondence to: David S. Gierada, Mallinckrodt Institute of Radiology, Box 8131, Washington University School of Medicine, 216 South Kingshighway Blvd, St. Louis, MO 63110; e-mail: gieradad{at}mir.wustl.edu

Background: Diaphragm position and shape on chest radiographs are routinely used as indicators of normal or abnormal lung volume. However, previous population studies of normal diaphragm position and shape frequently lack objective radiographic measurements and documentation of pulmonary function, and do not account for the observed variability.

Study objectives: To determine the spectrum of diaphragm position and shape on chest radiographs using objective measurements, in patients with normal pulmonary function, and to identify the relationship of diaphragm position and shape to demographic variables and radiographic thoracic dimensions.

Design: Prospective cross-sectional observational study.

Setting: University hospital.

Patients: One hundred fifty-three adults with normal FEV1 (≥ 80% predicted) and normal total lung capacity (80 to 120% predicted).

Measurements and results: Diaphragm position and shape relative to anatomic landmarks were determined from posteroanterior and lateral chest radiographs. We used descriptive statistics to calculate normal values, and linear correlation, two-tailed t tests, and multivariate analysis to relate findings to age, weight, gender, and thoracic dimensions. The right hemidiaphragm dome was positioned at 9.7 ± 0.8 thoracic vertebral levels (body plus disk space) [mean ± SD] below the top of the first thoracic vertebra (range, 7.4 to 11.3 vertebral levels), and the left hemidiaphragm dome was positioned at 10.2 ± 0.8 vertebral levels (range, 8.1 to 11.8 vertebral levels). The right hemidiaphragm radius was 13.8 ± 3.8 cm (range, 7.2 to 29.6 cm), and the ratio between the height and the anteroposterior dimension of the right hemidiaphragm was 0.23 ± 0.05 cm (range, 0.08 to 0.36 cm). The diaphragm tended to be lower with higher age, lower weight, and smaller transverse and anteroposterior thoracic dimensions (r = 0.22 – 0.47, p < 0.05), and flatter (larger radius) with higher age, weight, transverse thoracic dimension, pack-years smoked (r = 0.32 – 0.42, p < 0.0001), and male gender (p < 0.0001). The tested variables accounted for approximately one third of the variability in diaphragm position and shape (multivariate R2 = 0.31 - 0.38).

Conclusions: The substantial variability in normal diaphragm position and shape is related to weight, age, and thoracic dimensions. Consideration of these factors may be useful when evaluating chest radiographs.

Key Words: diaphragm • radiography • statistics • thoracic






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2003 by the American College of Chest Physicians.