Abstract Details

Title Neuromuscular Ultrasound for Evaluation of the Normal and Abnormal Diaphragm

Topic Muscle Disease/Neuromuscular Junction

Presentation(s) P05 - (-)

Poster/Presentation
Number 084

Objective

Background BACKGROUND: Diaphragmatic dysfunction may result from various causes, including phrenic nerve palsy, neuromuscular diseases or local chest pathology. Neuromuscular clinicians are often asked to evaluate the diaphragm for diagnostic and prognostic purposes. Traditionally, this evaluation is accomplished through history, physical exam, fluoroscopic sniff test, nerve conduction studies, and electromyography (EMG). Nerve conduction studies and EMG in this setting are challenging, uncomfortable, and can cause serious complications such as pneumothorax. Development of a non-invasive tool for functional and structural evaluation of the diaphragm is needed for differentiating the causes of diaphragmatic dysfunction in a timely fashion, which may impact management.

Design/Methods DESIGN/METHODS: An 18 MHz ultrasound transducer was used to visualize the diaphragm in the mid-axillary line using liver windows in a healthy individual, a patient with neuromuscular disease, and a patient with acute post-operative phrenic nerve injury causing diaphragm weakness. B mode was used to evaluate diaphragm thickness in the zone of apposition. Immobility of the diaphragm was established by repeated observation during breathing with no observed movement of diaphragm muscle.

Results RESULTS: The healthy contracting diaphragm could easily be seen through the 8-9th intercostal space "peeling away" from the chest wall with inspiration. In the patient with acute phrenic nerve palsy, the diaphragm was immobile but of normal thickness. In the patient with neuromuscular disease, the diaphragm appeared immobile and atrophic.

Conclusions CONCLUSIONS: These cases illustrate the use of neuromuscular ultrasound in differentiating between an immobile versus mobile diaphragm as well as an atrophic versus non-atrophic diaphragm. Neuromuscular ultrasound is a non-invasive and portable tool that can assist in the diagnosis and prognosis of diaphragmatic weakness, guiding management in patients with unexplained dyspnea or weaning failure.

Authors/Disclosures
Justin HALE, MD (Guam Regional Medical City, Neuroscience Center) PRESENTER	No disclosure on file
	No disclosure on file
Michael Cartwright, MD (Wake Forest School of Medicine)	Dr. Cartwright has received publishing royalties from a publication relating to health care.
Aarti Sarwal, MD, FAAN	Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stimdia, Inc. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Consultant for Sheinkei. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Society of Neuroimaging . The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . The institution of Dr. Sarwal has received research support from Image Monitoring. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ISICEM. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Secretary with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Member, Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Section Chair, Neurosciences Section with Society of Critical Care Medicine that is relevant to AAN interests or activities.
Arnfin Bergmann	Dr. Bergmann has nothing to disclose.

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