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First published online on January 15, 2008
Chest, doi:10.1378/chest.07-2200
doi:10.1378/chest.07-2200
(Chest. 2008; 133:737-743)
© 2008 American College of Chest Physicians
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Monitoring Recovery From Diaphragm Paralysis With Ultrasound*

Eleanor M. Summerhill, MD, FCCP; Yaser Abu El-Sameed, MD; Theresa J. Glidden, MD and F. Dennis McCool, MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI.

Correspondence to: Eleanor M. Summerhill, MD, FCCP, Pulmonary and Critical Care Medicine, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI 02860; e-mail: Eleanor_Summerhill_MD{at}Brown.edu

Abstract

Background: Diaphragmatic paralysis is an uncommon, yet underdiagnosed cause of dyspnea. Data regarding the time course and potential for recovery has come from a few small case series. The methods that have been traditionally employed to diagnose diaphragmatic weakness or paralysis are either invasive or limited in sensitivity and specificity. A new technique utilizing two-dimensional, B-mode ultrasound (US) measurements of diaphragm muscle thickening during inspiration ({Delta}tdi%) has been validated in the diagnosis of diaphragm paralysis (DP). The purpose of this study was to assess whether serial US evaluation might be utilized to monitor the potential recovery of diaphragm function.

Methods: Twenty-one consecutive patients with clinically suspected DP were referred to the pulmonary physiology laboratory. Sixteen patients were found to have DP by US (unilateral, 10 patients; bilateral, 6 patients). Subjects were followed up for up to 60 months. On initial and subsequent visits, {Delta}tdi% was measured by US. Additional measurements included upright and supine vital capacity (VC), maximal inspiratory pressure (PImax), and maximal expiratory pressure.

Results: Eleven of 16 patients functionally recovered from DP. The mean (± SD) recovery time was 14.9 ± 6.1 months. No diaphragm thickening was noted in those patients who did not recover. Positive correlations were found between improvement in {Delta}tdi% and interval changes in VC, PImax, and end-expiratory measurements of diaphragm thickness.

Conclusions: US may be used to assess for potential functional recovery from diaphragm weakness or DP. As in previous series, recovery occurs in a substantial number of individuals, but recovery time may be prolonged.

Key Words: diaphragm • diaphragm paralysis • diaphragm thickness • ultrasound






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