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Updated: Aug 19, 2026
Diaphragmatic Ultrasound in Adults: Image Acquisition and Interpretation
Published on: January 31, 2025
M-mode sonography of diaphragmatic motion: description of technique and experience in 278 pediatric patients
Mónica Epelman1, Oscar M Navarro, Alan Daneman
1Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. oscar.navarro@sickkids.ca
Insights
M-mode sonography effectively evaluates diaphragmatic motion in children, identifying dysfunction even when chest X-rays appear normal. This imaging technique is recommended for assessing diaphragmatic paralysis and monitoring changes over time.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Ultrasound Technology
Background:
- M-mode sonography for diaphragmatic motion assessment is underutilized in pediatric radiology.
- Previous reports involved small pediatric cohorts, limiting widespread adoption.
Purpose of the Study:
- To evaluate M-mode sonography for diaphragmatic motion in a large pediatric cohort with suspected diaphragmatic paralysis.
- To detail the sonographic technique and correlate findings with radiography and clinical outcomes.
Main Methods:
- Retrospective analysis of M-mode sonograms from September 1999 to December 2003.
- Correlation of sonographic findings with concurrent chest radiographs and clinical data.
Main Results:
- 742 hemidiaphragms in 278 children were analyzed.
- Abnormal diaphragmatic movement was detected in 63% of children with normal chest X-ray hemidiaphragm position.
- Follow-up showed improvement in 26, stability in 23, and deterioration in 7 of 56 children.
Conclusions:
- M-mode sonography is the preferred method for assessing diaphragmatic motion due to its ability to detect dysfunction.
- It facilitates follow-up comparisons and reveals diaphragmatic dysfunction missed by normal chest radiographs.
Background:
The use of M-mode sonography for evaluation of diaphragmatic motion has only been previously reported in small series of children, and its use is not widespread among pediatric radiologists.
Objectives:
To present our experience with M-mode sonography in the evaluation of diaphragmatic motion in a large number of children with suspected diaphragmatic paralysis, to describe the technique used and to correlate sonographic findings with chest radiographs and clinical outcome.
Materials And Methods:
Retrospective analysis of all M-mode sonograms performed in children from September 1999 to December 2003. The available chest radiographs and the clinical findings were reviewed and correlated with the sonographic findings.
Results:
A total of 742 hemidiaphragms were evaluated in 278 children. There was no visualization of the left hemidiaphragm in 2 children (0.71%). Movement of the right hemidiaphragm was normal in 238 and abnormal in 131. Movement of the left hemidiaphragm was normal in 232 and abnormal in 135. Abnormal diaphragmatic movement was present in 118 (63%) of 187 children in whom chest radiographs had shown normal position of the hemidiaphragms. Follow-up examinations were obtained in 56 children, revealing improvement in diaphragmatic motion in 26, no change in 23 and deterioration of motion in seven.
Summary:
M-mode sonography should be the modality of choice to assess diaphragmatic motion, as it can easily depict diaphragmatic dysfunction and allows comparison of changes in follow-up studies. Normal chest radiographs are poor predictors of normal diaphragmatic motion.
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