Transthoracic Ultrasonography for Evaluating Diaphragmatic Function in Patients with Non-expandable Lungs

Document Type : Original Article

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Department of Chest Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Background: Non-expandable lungs [NEL] are categorized into lung entrapment and trapped lungs, with distinct pathophysiologies. Patients with NEL are diagnosed by pleural manometry. Diaphragmatic dysfunction, often underdiagnosed due to non-specific presentation, can arise from various conditions. Diaphragmatic ultrasonography has evolved into an essential tool for assessing diaphragmatic function.  
Aim of the study: The study aimed to evaluate diaphragmatic function/ mobility using pulmonary ultrasound in NELs.
Patients and methods: Eighty-four patients with pleural effusion underwent transthoracic ultrasound. The M mode was used to evaluate lung motion, calculate the ventilation pulse index, and assess diaphragmatic copula motion during tidal and maximal breathing, leading to the calculation of the diaphragmatic excursion index. The B mode examined pleural fluid and thickness. Patients were classified into NEL [N=39] and Expanded lung groups [N=45].
Results: Lung motion during respiration and heartbeats were significantly reduced in NELs, showing high diagnostic accuracy [76.2% and 73.8%]. Both parameters had greater negative predictive values, indicating better exclusion of NELs. Ultrasound effectively assessed ipsilateral copula motion with maximal breathing [Sensitivity: 69.2%, Specificity: 75.6%, PPV: 71.1%, NPV: 73.9%] and the diaphragmatic excursion index [Sensitivity: 46.2%, Specificity: 71.1%, PPV: 58.1%, NPV: 60.4%].
Conclusion: Transthoracic ultrasonography is a reliable, non-invasive tool that is more effective at excluding rather than diagnosing NELs. Diaphragmatic ultrasound offers advantages such as non-invasiveness, no radiation, widespread availability, accuracy, and repeatability at the bedside.

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