• Annals of Clinical Neurophysiology
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• 제20권2호
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• pp.93-96
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• 2018

Evaluation of diaphragm function is challenging because no single test has a high diagnostic yield. We describe ultrasound findings in three cases with acquired unilateral diaphragmatic elevation. These cases confirm that sonographic evaluation is a valid tool for identifying diaphragm dysfunction. In addition, ultrasound measurements of diaphragm thickness and the contractility can be used to determine if a diaphragm is paralyzed and suggest the duration of paralysis (i.e., acute or chronic).

• Journal of Chest Surgery
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• 제6권2호
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• pp.243-248
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• 1973

Eventration of the diaphragm is, by definition, abnormally high or elevated position of diaphragm as a result of paralysis, aplasia or atrophy of varing degrees of muscle fibers, and the cause of which may be congenital or acquired. The unbroken continuity of the diaphragm differentiates it from diaphragmatic hernia. The clinical manifestations of the condition, if present, are usually due to the interference of the ventilatory function of the lung and digesive dysfunction due to gastrointestinal distorsion. Treatment consists of surgical repair of the relaxed diaphragm to it`s normal position. A ease of left sided eventuration of the diaphragm, 31 year old officer, was found by chance after traffic accident with chief complaints of hemoptysis and multiple superficial contusions. Routine chest roentgenogram and barium study of the colon revealed moderately elevated left hemidiaphragm with displacement of the splenic flexure of the colon into the left chest. Past history revealed frequent attack of upper respiratory infection and some abnormal condition on his left chest announced by screen cheek of chest X-ray at the time of entrance for his army service 3 years before. Plication of the relaxed diaphragm through left thoracotomy was done and result was excellent as seen on Fig. 5. Cause of eventration of the left hemidiaphragm was due to paralysis of the left phrenic nerve which was tested during thoracotomy.

• Journal of Chest Surgery
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• 제36권12호
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• pp.985-990
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• 2003

양측성 횡격막 마비는 드문 질환으로 외상, 심흉부 수술, 신경근육질병, 경부척추굳음증, 감염이 원인이 될 수 있다. 우폐상엽, 심낭, 상대정맥과 무명정맥을 침범한 흉선암의 적출술을 시행한 후 60세 남자 환자에서 양측성 횡격막 마비가 발생하였다. 심한 호흡곤란이 발생하였고, 인공호흡기 이탈이 불가능하였다. 양측 횡격막 주름성형술을 시행하였고, 인공호흡기 이탈 및 누운 자세에서 수면이 가능하게 되어 만족할 만한 결과를 얻었기에 문헌 보고하는 바이다.

• Journal of Chest Surgery
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• 제32권2호
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• pp.201-205
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• 1999

횡격막성 내장전위는 드문 질환이며 선천적인 원인에 의한다. 저자들은 기존에 좌측 횡격막성 내장전위가 있던 상태에서 교통사고로 인한 우측 횡격막 마비가 동반되어 호흡부전에 빠진 환자에 대한 수술을 시행하였다. 본 례는 국내외 문헌에 아직 보고된 례가 없는 매우 희귀한 경우로서 횡격막 주름성형술을 시행하여 좋은 결과를 얻었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제37권9호
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• pp.813-816
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• 2004

외상성 횡격막 파열은 방사선 검사로 진단하기가 어려운 경우가 빈번하다. 다발성 손상을 동반한 37세 남자 환자에서 횡격막 파열이 의심되었으나, 흉부 CT 검사에서는 횡격막 파열을 확인할 수는 없었고 진단을 위해 흉강경을 이용한 수술을 결정하였다. 횡격막 신경이 횡격막으로 들어가는 부위로부터 8 cm정도의 횡격막 파열이 있었고, 횡격막 마비를 동반하였다. 작업창을 5 cm크기로 추가하여 만든 후, 파열된 횡격막을 연속 봉합하였으며, 동시에 횡격막 주름성형술을 시행하였다. 수술 3개월후 시행한 흉부 방사선 사진에서 만족할 만한 결과를 보였다.

• The Korean Journal of Pain
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• 제33권2호
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• pp.144-152
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• 2020

Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.298-300
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• 2010

Diaphragmatic paralysis can be demonstrated through diaphragmatic elevation on chest X-ray after thoracic lung surgery or the placement of chest tubing. Additional causes of diaphragmatic paralysis are iatrogenic, mass, atelectasis, etc. For the diagnosis of diaphragmatic paralysis, it required some studies (fluoroscopy, computed tomography [CT], magnetic resonance imaging). Diaphragmatic hernia of the liver is a rare clinical entity, usually found after trauma in adults. Congenital diaphragmatic hernia in neonates requires surgery. Non-traumatic diaphragmatic hernia of the liver in an adult is a rare right-sided diaphragmatic hernia. On developing any symptoms, surgery must be performed. When diaphragmatic hernia is incidentally found in adults without trauma, it is placed under observation for a time period. We diagnosed the diaphragmatic herniation of a right hepatic lobe by 16-slice CT scan without surgery.

• Journal of Chest Surgery
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• 제3권2호
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• pp.113-120
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• 1970

Since the turn of the century there has been a constant search for a satisfactory method of controlling a large intrathoracic space following lobectomy. Primarily these methods consist of thoracoplasty, plombage, and phrenic nerve paralysis which are not completely satisfactory for they may result in loss of chest wall motility or diaphragmatic function. Incising the diaphragm at its periphery and resuturing to the chest wall at a level several rib spaces higher is an effective method of reducing intrathoracic space with minimal interference with pulmonary function. It is of particular value when the anticipated space problem is in the lower part of the thoracic cavity. Five cases are presented in which the diaphragm was peripherally detached and advanced to higher levels. Two cases were following lower lobectomy and three cases were following decortication for chronic empyema in which expansion was not good enough to adequately fill the space. Results in these cases were satisfactory.

• Journal of Chest Surgery
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• 제15권3호
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• pp.290-294
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• 1982

Diaphragmatic eventration is a rare disease, congenital or acquired, high or elevated position of one leaf of the diaphragm muscle, as a result of paralysis, aplasia or atrophy of varying degree of the muscle fibers of the affected side but with no break in the continuity of the muscle. We experienced 3 cases of the diaphragmetic eventration at the department of thoracic surgery, C.A.F.G.H., from 1980 to 1982, which were treated successfully. Among three cases, one case combinded with hamartoma of the ipsilateral lung. Specific complications were not noticed after surgical repair of diaphramatic eventration with good result.

• Journal of Chest Surgery
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• 제35권10호
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• pp.730-735
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• 2002

횡격막은 횡격막 신경과 동측의 하 흉벽 늑간신경의 지배를 받는다. 상완신경총의 적출 손상을 가진 환자에서 신경총의 일부 신경의 신경이식술에 횡경막 신경의 신경 이식편이 종종 이용된다. 이와 같이 횡격막 신경이 신경이식편으로 사용된 환자에서 횡격막 신경의 탈신경으로 인하여 발생하는 횡격막의 위치 및 운동의 변화를 연구하였다. 대상 및 방법 : 어께의 둔상으로 상완신경총의 적출 손상 때문에 동측의 횡격막 신경으로 근피부신경에 신경이식술을 시행한 13예를 대상으로 하였다. 흉강경 수술방법으로 흉강 내 횡격막 신경을 박리하고 횡격막 바로 위에서 횡격막 신경을 절단하여 경부 절개창을 통해서 외부로 끌어낸 다음 피하 터널을 통해서 동측의 근피부신경에 이식하였다. 엑스선 투시검사와 흉부 엑스선 촬영으로 수술 전후의 횡격막 위치 및 운동 상태를 조사하였다. 결과 : 흉강경을 이용하여 횡격막 신경을 박리 절단하는데 기술적 어려움이나 경미한 합병증도 없었다. 횡격막 신경의 절단 직후에는 횡격막이 평균 1.7 늑간 정도 올라가 있었으나, 엑스선 투시검사에서 흡기시 횡격막의 역행성 운동은 보이지 않았다. 1.5개월 이후의 엑스선 검사에서 횡격막의 위치는 수술 전에 비해 유의한 차이 없을 정도(평균 0.9 늑간 차이; p＝NS로 복원되었다. 횡격막 신경의 절단으로 횡격막의 운동 범위는 탈신경 전에 비해 유의한 차이가 없었다. 결론 : 횡격막 신경의 차단으로 인한 탈신경 후 횡격막의 운동기능은 남아 있었으며 횡격막의 위치는 시간이 경과함에 따라 어느 정도 회복되는 현상을 보였다. 그러나 폐활량이 계속 감소된 소견은 횡격막의 흡기력이 완전히 회복되지 않았음을 추정할 수 있다.