Sonographic evaluation of diaphragmatic dysfunction in COPD patients

Figures & data

Figure 1 Sonographic measurement of the up- and downward movement of the lung silhouette – here on the right side.

Notes: The patient is sitting; the transducer is placed at the lowest point of the lung silhouette in the scapular line. While the patient breathes as deeply as possible a video sequence is performed. Afterward the distance between maximal inspiration and maximal expiration can be measured.

Figure 2 Sonografic measurement of the maximum lung movement.

Notes: (A) Sonographic measurement of the up- and downward movement of the lung silhouette – here on the right side. E marks the lowest point of the lung silhouette at maximal end expiration. (B) Sonographic measurement of the up- and downward movement of the lung silhouette – here on the right side. E marks the lowest point of the lung silhouette at maximal end expiration, and I marks the lowest point at maximal inspiration. In this example, the distance between E and I is 28 mm.

Figure 3 Correlation of both sonographic measurements of diaphragmatic movement of the right hemidiaphragm.

Notes: Scapular line means the sonographically measured distance of the lung silhouette movement between deep inhalation and deep exhalation on the right hemidiaphragm. Anterior axillary line means the sonographic measurement of the diaphragm dome with the liver used as ultrasound window. Correlation is high (r=0.85).

Table 1 Diaphragmatic movement measured using the lung silhouette method and the anterior method in the different patient groups

	Lung silhouette (mm)	Anterior (mm)
COPD II	43	46
COPD III	30	37
COPD IV	25	31
Control group	65	68

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 4 Correlation of diaphragmatic movement and FEV1 in COPD patients and healthy volunteers.

Notes: The diaphragmatic movement was measured sonographically by the distance of the lung silhouette movement between deep inhalation and deep exhalation of both hemidiaphragms. For each patient, the medium of the measured distances of both hemidiaphragms was calculated. Correlation is high (r=0.83).
Abbreviations: FEV1, forced expiratory volume in the first second; COPD, chronic obstructive pulmonary disease.