Validation of Point-of-Care ultrasound in the diagnosis of a diaphragmatic hernia

Rev Esp Anestesiol Reanim (Engl Ed). 2023 Aug-Sep;70(7):404-408. doi: 10.1016/j.redare.2022.05.005. Epub 2023 Aug 7.

Abstract

Point-of-care ultrasound (POCUS) is a sensitive, specific tool for early diagnosis of diaphragm pathology in critically ill patients. We report the case of a patient with a history of iatrogenic diaphragmatic hernia who was admitted to the Resuscitation Unit after an emergency exploratory laparotomy. As the diagnosis of diaphragmatic hernia had already been confirmed, we determined the POCUS features that establish the diagnosis of diaphragmatic hernia: (1) normal bilateral diaphragmatic shortening fraction; (2) decreased diaphragmatic excursion; and (3) cephalic position of the diaphragmatic dome (4) greater in supine than in sitting position. We also outline a systematic ultrasound examination of the diaphragm and a POCUS-based differential classification of diaphragmatic dysfunction based on the functional integrity of the peripheral muscle and central diaphragmatic tendon in critically ill patients.

Keywords: Case report; Caso clínico; Diaphragmatic hernia; Ecografía; Hernia diafragmática; Parálisis respiratoria; Point-of-CARE; Point-of-Care; Respiratory paralysis; Resuscitation unit; Ultrasound; Unidad de reanimación.

Publication types

  • Case Reports

MeSH terms

  • Critical Illness*
  • Diaphragm / diagnostic imaging
  • Hernia, Diaphragmatic* / diagnosis
  • Humans
  • Point-of-Care Systems
  • Ultrasonography