Transthoracic Ultrasonography for Evaluating Diaphragmatic Function in Patients with Non-expandable Lungs | ||||
| International Journal of Medical Arts | ||||
| Articles in Press, Accepted Manuscript, Available Online from 05 July 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ijma.2025.385867.2185 | ||||
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| Authors | ||||
Ahmed A G Nofal  ; Tamer Mohammed Ibraheem
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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 lung, with distinct pathophysiologies. 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 aims to evaluate diaphragmatic function 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%). Conclusions: 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. | ||||
| Keywords | ||||
| Pleural Effusion; Non-expanded Lung; Diaphragmatic Ultrasound | ||||
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