Chest
Clinical InvestigationsMiscellaneousVariation in Diaphragm Position and Shape in Adults With Normal Pulmonary Functiona
Section snippets
Patient Selection
The study protocol was approved by the local human studies committee. From 5,100 patients referred for pulmonary function tests at our institution between January and August of 2000, 492 patients had normal findings, excluding those who underwent lung transplantation. Of these 492 patients, 316 patients had an available two-view chest radiographic examination performed within 2 months of pulmonary function testing and were considered for inclusion. Of these, 78 patients were excluded due to a
Diaphragm Position and Shape
The mean right hemidiaphragm dome position was at 9.7 ± 0.8 vertebral levels. This is slightly above the inferior endplate of the tenth thoracic vertebral body (T10), and 0.9 ± 2.3 cm above the right crossing rib level. The mean left hemidiaphragm dome position was 0.5 vertebral levels lower than the right, 0.3 ± 2.4 cm below the left crossing rib level (Table 2). The mean position of the right and left hemidiaphragm domes was higher in the obese subgroup (Table 2). In the nonobese subgroup,
Discussion
A previous major study defining normal diaphragm position on chest radiographs3used the anterior ribs as an anatomic reference, and this is often recommended to those learning to interpret chest radiographs. However, referencing diaphragm position to the anterior ribs can be difficult, since the contours of the anterior ribs and diaphragm domes are not parallel, and the costal portions of the anterior ribs may not be clearly visible. Relating diaphragm position to the thoracic spine has been
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