Imaging of the Diaphragm

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.25
Procedures: 2.25
Neck and Chest: 2.25

Magnetic Resonance Imaging: 2.25
Procedures: 2.25
Body: 2.25

Radiography: 2.25
Procedures: 2.25
Thorax and Abdomen Procedures: 2.25

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Thoracic Section: 3.25

Sonography: 2.25
Procedures: 2.25
Superficial Structures and Other Sonographic Procedures: 2.25

Outline

1. Introduction
2. Embryology
3. Anatomy
   1. Attachments
   2. Innervation
   3. Hiatuses
4. Function
5. Dysfunction
   1. Paralysis and Weakness
   2. Eventration
   3. Mimics
6. Fluoroscopic Sniff Test
   1. Technique
   2. Normal Findings
   3. Abnormal Findings
   4. Technical Adjustments for Special Patients
7. US and MR Imaging
8. Treatment
   1. Plication
   2. Phrenic Nerve Stimulation
9. Summary

Objectives

Upon completion of this course, students will:

1. understand the role of the diaphragm in the breathing process
2. be able to describe the anatomical components of the diaphragm
3. be familiar with the key imaging modalities that are used to visualize the diaphragm
4. describe the embryological development of the diaphragm
5. understand the patient symptoms of diaphragmatic dysfunction
6. know what four structures come together in the embryonic process to make the diaphragm
7. know what weeks of embryogenesis the diaphragm develops in
8. describe the two primary types of congenital diaphragmatic hernias
9. identify the difference between Morgagni and Bolchdalek hernias
10. be able to identify which congenital diaphragmatic hernia is the most common
11. understand what associated anomalies could coincide with congenital diaphragmatic hernias
12. know which imaging modality is considered the most accurate method of diagnosing and evaluating congenital diaphragmatic disorders
13. understand how the diaphragm is presented on a sonogram
14. know which view best delineates the diaphragm on a sonogram
15. be familiar with the sonographic findings in diagnosing congenital diaphragmatic hernias
16. describe what a hiatal hernia is
17. be able to differentiate a hiatal hernia from a Morgagni or Bolchdalek hernia
18. understand the two main types of hiatal hernias
19. understand the imaging modality used to diagnose a hiatal hernia
20. describe a Schatzki’s ring
21. describe which radiographic view best visualizes the gastroesophageal junction and any potential hiatal hernias
22. be familiar with the appropriate kVp setting for performing a GI barium study
23. define what the costophrenic angle is and its relationship to the diaphragm
24. define what the cardiophrenic angle is and its relationship to the diaphragm
25. understand what the diaphragmatic crura are and their anatomical position
26. understand the anatomy and makeup of the peripheral muscular, central tendinous part and domes of the diaphragm
27. describe the medial and lateral arcuate ligaments and their anatomical position in relation to the diaphragm
28. understand the physiology of the diaphragm including its role in regulation of oxygen and partial elimination of carbon dioxide
29. describe what other roles the diaphragm plays
30. understand how diaphragmatic dysfunction is categorized
31. understand the differential diagnosis to consider when an elevated hemidiaphragm is visualized on a chest radiograph
32. describe what eventration of the diaphragm is
33. understand what conditions can cause an elevation in the diaphragm and mimic diaphragmatic disease
34. describe the sniff test and its use in fluoroscopic testing of the diaphragm
35. understand the various maneuvers and how they can define diaphragmatic disease during a fluoroscopic sniff test
36. define the role of sonography in diagnosing diaphragmatic disease
37. define the role of dynamic MR imaging in diagnosing diaphragmatic disease
38. understand which sequences are used in dynamic MR imaging to diagnose diaphragmatic disease
39. describe the surgical process of the plication of the diaphragm for treatment of diaphragmatic disease
40. describe the surgical process of phrenic nerve stimulation for treatment of diaphragmatic disease