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Original Research: Imaging |

B-Mode Ultrasound Assessment of Diaphragm Structure and Function in Patients With COPDDiaphragm Structure and Function in COPD

Michael R. Baria, MD; Leili Shahgholi, MD; Eric J. Sorenson, MD; Caitlin J. Harper, BS; Kaiser G. Lim, MD; Jeffrey A. Strommen, MD; Carl D. Mottram, RRT; Andrea J. Boon, MBChB
Author and Funding Information

From the Department of Physical Medicine and Rehabilitation (Drs Baria, Shahgholi, Strommen, and Boon), the Division of Clinical Neurophysiology (Drs Sorenson, Strommen, and Boon), Department of Neurology, the Mayo Medical School (Ms Harper), the Department of Pulmonary and Critical Care Medicine (Dr Lim and Mr Mottram), and the Division of Allergic Diseases (Dr Lim), Mayo Clinic and Foundation, Rochester, MN.

CORRESPONDENCE TO: Andrea J. Boon, MBChB, Department of Physical Medicine and Rehabilitation and Division of Clinical Neurophysiology, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: boon.andrea@mayo.edu


This study was presented at the International Conference and Course on Neuromuscular Ultrasound, May 16-18, 2013, Charleston, SC.

FUNDING/SUPPORT: This publication was made possible by the Mayo Clinic Center for Translation Science Activities [Grant UL1 TR000135] from the National Center for Advancing Translational Science, a component of the National Institutes of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):680-685. doi:10.1378/chest.13-2306
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BACKGROUND:  Electromyographic evaluation of diaphragmatic neuromuscular disease in patients with COPD is technically difficult and potentially high risk. Defining standard values for diaphragm thickness and thickening ratio using B-mode ultrasound may provide a simpler, safer means of evaluating these patients.

METHODS:  Fifty patients with a diagnosis of COPD and FEV1 < 70% underwent B-mode ultrasound. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The thickening ratio was calculated as (Tmax/Tmin), and each set of values was averaged. Findings were compared with a database of 150 healthy control subjects.

RESULTS:  There was no significant difference in diaphragm thickness or thickening ratio between sides within groups (control subjects or patients with COPD) or between groups, with the exception of the subgroup with severe air trapping (residual volume > 200%), in which the only difference was that the thickening ratio was higher on the left (P = .0045).

CONCLUSIONS:  In patients with COPD presenting for evaluation of coexisting neuromuscular respiratory weakness, the same values established for healthy control subjects serve as the baseline for comparison. This knowledge expands the role of ultrasound in evaluating neuromuscular disease in patients with COPD.

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