ACR Appropriateness Criteria® Suspected Diaphragm Dysfunction

Diaphragm dysfunction includes diaphragmatic eventration, weakness, and paralysis, a set of disorders which are often challenging to diagnose clinically due to their varied presenting symptoms including dyspnea, positional orthopnea, cough, or even chest pain. Given the clinical challenge in diagnosing these conditions, diaphragm dysfunction is often suggested incidentally on initial imaging for workup of these symptoms. Imaging can play an important role both in raising the initial suspicion for diaphragm dysfunction as well as in making the diagnosis through real-time evaluation of the diaphragm's function. This document focuses on the initial imaging of suspected diaphragm dysfunction to confirm the diagnosis and evaluate for underlying leading to the dysfunction. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.