Alisanant Chanakarn, Neungton Pira, Iemsawatdikul Kriengkrai
J Med Assoc Thai. 2016 Oct;99(10):1142-6.
There are many causes affecting diaphragmatic height including normal variation and pathology. Both elevation and depression of the diaphragm imply various pathologies. In our knowledge, no previous study of newborn evaluated the different height of diaphragms. Using adult’s reference value in interpretation of newborns’ chest remains doubtful because of different imaging technique.
To assess diaphragmatic height and measure different height of diaphragms in the chest radiographs of newborns.
A retrospective review of chest radiographs was performed on 100 newborns (age less than 1 month) who were diagnosed of transient tachypnea of the newborn (TTNB) that had respiratory distress and abnormalities in chest radiographs disappeared. The diaphragmatic positions and different diaphragmatic height were evaluated in relation to thoracic vertebra and posterior rib.
Right diaphragmatic dome was positioned at 8.17+0.72 thoracic vertebral levels below the top of first thoracic vertebra and 8.28+0.78 crossing rib levels. Left diaphragmatic dome was positioned at 8.87+0.71 thoracic vertebral levels and 8.91+0.29 crossing rib levels. The different height of diaphragms was 0.70+0.34 thoracic vertebral body and 0.63+0.29 intercostal spaces. No newborn had the left diaphragmatic dome higher than the right side.
The different diaphragmatic height in newborns is less than 1 intercostal space or 1 thoracic vertebral level. This knowledge is useful for assessment of chest radiographs.
影响膈肌高度的因素众多,包括正常变异和病理情况。膈肌的升高和降低均提示多种病理状态。据我们所知,此前尚无针对新生儿膈肌不同高度的研究。由于成像技术不同,在解读新生儿胸部影像时采用成人的参考值仍存在疑问。
评估新生儿胸部X线片上的膈肌高度并测量膈肌的不同高度。
对100例诊断为新生儿暂时性呼吸急促(TTNB)且有呼吸窘迫、胸部X线片异常随后消失的新生儿(年龄小于1个月)的胸部X线片进行回顾性分析。根据胸椎和后肋评估膈肌位置及不同的膈肌高度。
右膈顶位于第一胸椎椎体顶部下方8.17±0.72个胸椎水平及第8.28±0.78根肋骨水平。左膈顶位于8.87±0.71个胸椎水平及8.91±0.29根肋骨水平。膈肌的不同高度为0.70±0.34个椎体和0.63±0.29个肋间间隙。无一例新生儿左膈顶高于右侧。
新生儿膈肌的不同高度小于1个肋间间隙或1个胸椎水平。这一认识有助于胸部X线片的评估。