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a-j US images for a 52-year-old male patient with a history of cardiothoracic surgery 6 months ago presented with elevated left copula of the diaphragm in his CT. a, b US images-anterior subcostal view (a) and intercostals view (b) showing normal US appearance of both hemidiaphragms with no defect detected on either side. c, d US image using superficial probe through an intercostal view showing a diaphragmatic thickness (RT = 1.9 mm (c, between the red dots)/LT = 1.3 mm {thin, atrophic } (d, between the red dots)) with a thickening fraction (RT = 45%/LT = 10%). e-j Anterior subcostal and intercostal views used for assessment of diaphragmatic excursion (RT = 2.1 cm in normal breathing (e, between red dots)/= 5 cm in deep breathing (g, between the red dots)/=4 cm in sniffing (i, between the red dots) and the left side showed absent movement in normal (f), deep breathing (h), and sniffing (j). Findings were consistent with left hemidiaphragmatic paralysis to be likely a postoperative sequlae
Source publication
Background
To evaluate the role of the trans-abdominal ultrasound (TAUS) in the assessment of hemidiaphragmatic dysfunction—due to non-pulmonic causes—as compared to the conventional CT; 36 patients (22 males and 14 females; age range 5 to 84 years) were included in this study.
Results
In CT examination, the dysfunctional hemidiaphragm was conside...
Context in source publication
Context 1
... weakness was indicated by decreased (lessthan-normal) amplitudes of excursion on deep breathing with or without paradoxical motion upon sniffing, whereas a diaphragmatic paralysis was indicated by diminished (absence of) excursion with quiet and deep breathing and with absence of motion or paradoxical movement on sniffing (Figs. 5 and 6). The direction of diaphragmatic motion could be identified by the TAUS and correlated to the respiratory phases and paradoxical motion was identified when the diaphragm was moving away from the probe in the inspiratory phase (the reverse of the expected ...
Citations
... It is strategically located in the body as it separates abdominal contents from structures in the thoracic cavity (2). Abnormalities of the diaphragm can be unilateral rarely bilateral, are CASE REPORT OPEN ACCESS 34 commoner on the left (1,3,4). Most unilateral diaphragmatic abnormalities are asymptomatic (1). ...
... Some diaphragmatic abnormalities include hernia, paralysis, and diaphragmatic hump (3). Common causes of diaphragmatic humps or eventrations on chest radiographs include Morgagni hernia, dilated right atrium, primary lung mass, anterior mediastinum mass, lymph nodes (Hodgkin's lymphoma), aneurysm, lung cysts, and abscesses (3,4). The association of diaphragmatic abnormalities on chest radiographs with chest infection has been well documented (3). ...
... It is strategically located in the body as it separates abdominal contents from structures in the thoracic cavity (2). Abnormalities of the diaphragm can be unilateral rarely bilateral, are CASE REPORT OPEN ACCESS 34 commoner on the left (1,3,4). Most unilateral diaphragmatic abnormalities are asymptomatic (1). ...
... Some diaphragmatic abnormalities include hernia, paralysis, and diaphragmatic hump (3). Common causes of diaphragmatic humps or eventrations on chest radiographs include Morgagni hernia, dilated right atrium, primary lung mass, anterior mediastinum mass, lymph nodes (Hodgkin's lymphoma), aneurysm, lung cysts, and abscesses (3,4). The association of diaphragmatic abnormalities on chest radiographs with chest infection has been well documented (3). ...
Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology.
Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs.
Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon.
Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.
