{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:34:42Z","timestamp":1788449682730,"version":"build-2803163510"},"reference-count":97,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Diaphragm ultrasound makes it possible to diagnose diaphragmatic atrophy and dysfunction. Important indications include unclear dyspnea; diaphragmatic elevation; assessment of diaphragm dysfunction in pulmonary, neuromuscular and neurovascular diseases; and in critically ill patients before noninvasive and mechanical ventilation and follow-up of diaphragm thickness and function during mechanical ventilation with potential prediction of prolonged weaning. In patients with respiratory insufficiency and potential diaphragm dysfunction, it is possible to objectify the contribution of diaphragm dysfunction. In addition, assessment of diaphragmatic hernias, tumors and diaphragmatic dysfunction in COVID-19 and diaphragmatic ultrasound in sports medicine have been described. This narrative review includes the sonomorphology of the diaphragm, standardization of ultrasonographic investigation with transducer positions and ultrasound techniques, normal findings and diagnostic criteria for pathological findings. The correct sonographic measurement, calculation and evaluation can ultimately influence further therapeutic procedures for the patient suffering from diaphragm dysfunction in various diseases.<\/jats:p>","DOI":"10.3390\/life15020239","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T04:47:31Z","timestamp":1738817251000},"page":"239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Perception of the Diaphragm with Ultrasound: Always There Yet Overlooked?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9492-0141","authenticated-orcid":false,"given":"Kathleen","family":"M\u00f6ller","sequence":"first","affiliation":[{"name":"Medical Department I\/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Saborio","sequence":"additional","affiliation":[{"name":"Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Gottschall","sequence":"additional","affiliation":[{"name":"Medical Department I\/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Blaivas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC 29209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian C.","family":"Borges","sequence":"additional","affiliation":[{"name":"Medical Department II\/Cardiology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Morf","sequence":"additional","affiliation":[{"name":"Center da Sand\u00e0 Val M\u00fcstair, 7536 Sta. Maria, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8769-6167","authenticated-orcid":false,"given":"Burkhard","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6347","authenticated-orcid":false,"given":"Christoph F.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/mus.27639","article-title":"Association of diaphragm thickness and echogenicity with age, sex, and body mass index in healthy subjects","volume":"66","author":"Wijntjes","year":"2022","journal-title":"Muscle Nerve"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1136\/thx.50.11.1157","article-title":"In vivo assessment of diaphragm contraction by ultrasound in normal subjects","volume":"50","author":"Ueki","year":"1995","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1159\/000506016","article-title":"Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations","volume":"99","author":"Spiesshoefer","year":"2020","journal-title":"Respiration"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13054-022-03975-5","article-title":"EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): A Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting","volume":"26","author":"Haaksma","year":"2022","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Laghi, F.A., Saad, M., and Shaikh, H. (2021). Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction. BMC Pulm. Med., 21.","DOI":"10.1186\/s12890-021-01441-6"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1002\/mus.23702","article-title":"Two-dimensional ultrasound imaging of the diaphragm: Quantitative values in normal subjects","volume":"47","author":"Boon","year":"2013","journal-title":"Muscle Nerve"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1007\/s00134-015-3687-3","article-title":"Measuring diaphragm thickness with ultrasound in mechanically ventilated patients: Feasibility, reproducibility and validity","volume":"41","author":"Goligher","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Boussuges, A., Rives, S., Finance, J., Chaumet, G., Vallee, N., Risso, J.J., and Bregeon, F. (2021). Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position. Front. Med., 8.","DOI":"10.3389\/fmed.2021.742703"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1164\/ajrccm.155.5.9154859","article-title":"Ultrasound evaluation of the paralyzed diaphragm","volume":"155","author":"Gottesman","year":"1997","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s40477-020-00462-x","article-title":"Evaluation of diaphragm thickening by diaphragm ultrasonography: A reproducibility and a repeatability study","volume":"24","author":"Cappellini","year":"2021","journal-title":"J. Ultrasound"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"920","DOI":"10.4187\/respcare.03999","article-title":"Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers","volume":"61","year":"2016","journal-title":"Respir. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.ultrasmedbio.2017.11.020","article-title":"Diaphragmatic Ultrasound Correlates with Inspiratory Muscle Strength and Pulmonary Function in Healthy Subjects","volume":"44","author":"Cardenas","year":"2018","journal-title":"Ultrasound Med. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.resp.2018.12.004","article-title":"Reproducibility of diaphragmatic thickness measured by M-mode ultrasonography in healthy volunteers","volume":"260","author":"Scarlata","year":"2019","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s00408-023-00662-2","article-title":"Diaphragm Ultrasonography: Reference Values and Influencing Factors for Thickness, Thickening Fraction, and Excursion in the Seated Position","volume":"202","author":"Yamada","year":"2024","journal-title":"Lung"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4015","DOI":"10.2147\/IJGM.S478136","article-title":"Diaphragm Assessment by Multimodal Ultrasound Imaging in Healthy Subjects","volume":"17","author":"Zhang","year":"2024","journal-title":"Int. J. Gen. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1159\/000489229","article-title":"Reproducibility and Clinical Correlates of Supine Diaphragmatic Motion Measured by M-Mode Ultrasonography in Healthy Volunteers","volume":"96","author":"Scarlata","year":"2018","journal-title":"Respiration"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.12998\/wjcc.v8.i12.2408","article-title":"Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives","volume":"8","author":"Boussuges","year":"2020","journal-title":"World J. Clin. Cases"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.pmrj.2016.06.001","article-title":"Comparison of Diaphragm Thickness Measurements Among Postures Via Ultrasound Imaging","volume":"9","author":"Hellyer","year":"2017","journal-title":"PM R"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/CPT.0000000000000083","article-title":"Body Position Affects Ultrasonographic Measurement of Diaphragm Contractility","volume":"29","author":"Brown","year":"2018","journal-title":"Cardiopulm. Phys. Ther. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5492\/wjccm.v6.i4.185","article-title":"Reproducibility of diaphragm thickness measurements by ultrasonography in patients on mechanical ventilation","volume":"6","author":"Dhungana","year":"2017","journal-title":"World J. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1136\/thoraxjnl-2013-204111","article-title":"Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation","volume":"69","author":"DiNino","year":"2014","journal-title":"Thorax"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.pulmoe.2018.10.008","article-title":"Diaphragmatic dysfunction","volume":"25","author":"Ricoy","year":"2019","journal-title":"Pulmonology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"506","DOI":"10.6061\/clinics\/2016(09)04","article-title":"Is polysomnographic examination necessary for subjects with diaphragm pathologies?","volume":"71","author":"Oruc","year":"2016","journal-title":"Clinics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1007\/s11325-021-02422-z","article-title":"Sleep-related breathing disorders in diaphragmatic pathologies","volume":"26","author":"Sarac","year":"2022","journal-title":"Sleep Breath."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e801","DOI":"10.1097\/MD.0000000000000801","article-title":"Interest of Ultrasonographic Assessment of Diaphragmatic Function in Cardiac Rehabilitation Center: A Case Report","volume":"94","author":"Boussuges","year":"2015","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/cpf.12549","article-title":"Characteristics of the paralysed diaphragm studied by M-mode ultrasonography","volume":"39","author":"Boussuges","year":"2019","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1038\/sj.sc.3101889","article-title":"Diaphragmatic paralysis: The use of M mode ultrasound for diagnosis in adults","volume":"44","author":"Lloyd","year":"2006","journal-title":"Spinal Cord"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1002\/mus.24059","article-title":"Visualization of the diaphragm muscle with ultrasound improves diagnostic accuracy of phrenic nerve conduction studies","volume":"49","author":"Johnson","year":"2014","journal-title":"Muscle Nerve"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0009-9260(05)82987-3","article-title":"Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality","volume":"50","author":"Houston","year":"1995","journal-title":"Clin. Radiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s41747-024-00491-9","article-title":"Automated evaluation of diaphragm configuration based on chest CT in COPD patients","volume":"8","author":"Bakker","year":"2024","journal-title":"Eur. Radiol. Exp."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Leal, B.E., Goncalves, M.A., Lisboa, L.G., Linne, L.M.S., Tavares, M.G.S., Yamaguti, W.P., and Paulin, E. (2017). Validity and reliability of fluoroscopy for digital radiography: A new way to evaluate diaphragmatic mobility. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0402-x"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.25259\/JCIS_138_2019","article-title":"Magnetic Resonance Imaging of the Diaphragm: From Normal to Pathologic Findings","volume":"10","author":"Cicero","year":"2020","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2519\/jospt.2013.4931","article-title":"Variability in diaphragm motion during normal breathing, assessed with B-mode ultrasound","volume":"43","author":"Harper","year":"2013","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1378\/chest.07-2200","article-title":"Monitoring recovery from diaphragm paralysis with ultrasound","volume":"133","author":"Summerhill","year":"2008","journal-title":"Chest"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Barbariol, F., Deana, C., Guadagnin, G.M., Cammarota, G., Vetrugno, L., and Bassi, F. (2021). Ultrasound diaphragmatic excursion during non-invasive ventilation in ICU: A prospective observational study. Acta Biomed., 92.","DOI":"10.21203\/rs.3.rs-17612\/v1"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1378\/chest.11-1638","article-title":"Diaphragm muscle thinning in patients who are mechanically ventilated","volume":"142","author":"Grosu","year":"2012","journal-title":"Chest"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s13054-015-1141-0","article-title":"The course of diaphragm atrophy in ventilated patients assessed with ultrasound: A longitudinal cohort study","volume":"19","author":"Schepens","year":"2015","journal-title":"Crit. Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1097\/CCM.0000000000001657","article-title":"Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study","volume":"44","author":"Zambon","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.4187\/respcare.04746","article-title":"Diaphragmatic Dysfunction Is Characterized by Increased Duration of Mechanical Ventilation in Subjects with Prolonged Weaning","volume":"61","author":"Lu","year":"2016","journal-title":"Respir. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/jum.16363","article-title":"Ultrasonography to Access Diaphragm Dysfunction and Predict the Success of Mechanical Ventilation Weaning in Critical Care: A Narrative Review","volume":"43","author":"Marques","year":"2024","journal-title":"J. Ultrasound Med."},{"key":"ref_41","first-page":"1149","article-title":"Diaphragmatic ultrasonography as an adjunct predictor tool of weaning success in patients with difficult and prolonged weaning","volume":"82","author":"Flevari","year":"2016","journal-title":"Minerva Anestesiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13089-018-0094-3","article-title":"Lung and diaphragm ultrasound as predictors of success in weaning from mechanical ventilation","volume":"10","year":"2018","journal-title":"Crit. Ultrasound J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1136\/thx.49.9.890","article-title":"Diaphragmatic movement in hemiplegic patients measured by ultrasonography","volume":"49","author":"Cohen","year":"1994","journal-title":"Thorax"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.resp.2011.05.017","article-title":"Effects of hemiplegy on pulmonary function and diaphragmatic dome displacement","volume":"178","author":"Clementino","year":"2011","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Liu, X., Qu, Q., Deng, P., Zhao, Y., Liu, C., Fu, C., and Jia, J. (2022). Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function. Brain Sci., 12.","DOI":"10.3390\/brainsci12070882"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/JND-170276","article-title":"Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders","volume":"5","author":"Fayssoil","year":"2018","journal-title":"J. Neuromuscul. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Fantini, R., Tonelli, R., Castaniere, I., Tabb\u00ec, L., Pellegrino, M.R., Cerri, S., Livrieri, F., Giaroni, F., Monelli, M., and Ruggieri, V. (2019). Serial ultrasound assessment of diaphragmatic function and clinical outcome in patients with amyotrophic lateral sclerosis. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-0924-5"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1002\/mus.27980","article-title":"The utility of diaphragm ultrasound thickening indices for assessing respiratory decompensation in amyotrophic lateral sclerosis","volume":"68","author":"Spiliopoulos","year":"2023","journal-title":"Muscle Nerve"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1136\/thx.52.5.472","article-title":"Diaphragm thickness and inspiratory strength in patients with Duchenne muscular dystrophy","volume":"52","author":"Ueki","year":"1997","journal-title":"Thorax"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"55","DOI":"10.3233\/JND-180326","article-title":"Echographic Assessment of Diaphragmatic Function in Duchenne Muscular Dystrophy from Childhood to Adulthood","volume":"6","author":"Fayssoil","year":"2019","journal-title":"J. Neuromuscul. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4103\/lungindia.lungindia_466_18","article-title":"Study of the diaphragm in chronic obstructive pulmonary disease using ultrasonography","volume":"36","author":"Jain","year":"2019","journal-title":"Lung India"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1016\/j.rmed.2007.05.024","article-title":"Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD","volume":"101","author":"Paulin","year":"2007","journal-title":"Respir. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.4187\/respcare.06803","article-title":"Diaphragmatic Ultrasound Assessment in Subjects with Acute Hypercapnic Respiratory Failure Admitted to the Emergency Department","volume":"64","author":"Cammarota","year":"2019","journal-title":"Respir. Care"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajem.2020.08.014","article-title":"Diaphragm dysfunction detected with ultrasound to predict noninvasive mechanical ventilation failure: A prospective cohort study","volume":"45","author":"Kocyigit","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1016\/j.ajem.2016.05.055","article-title":"Diaphragmatic excursion measurement in emergency patients with acute dyspnea: Toward a new diagnostic tool?","volume":"34","author":"Bobbia","year":"2016","journal-title":"Am. J. Emerg. Med."},{"key":"ref_56","first-page":"10950","article-title":"Diaphragmatic dysfunction evaluation using ultrasonography as a predictor of weaning for patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease from mechanical ventilation","volume":"4","author":"Fayed","year":"2016","journal-title":"J. Med. Sci. And. Clin. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"457","DOI":"10.2147\/COPD.S338583","article-title":"Assessments and Targeted Rehabilitation Therapies for Diaphragmatic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review","volume":"17","author":"Chen","year":"2022","journal-title":"Int. J. Chron. Obs. Pulmon Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1183\/09031936.97.10010059","article-title":"Size and strength of the respiratory and quadriceps muscles in patients with chronic asthma","volume":"10","author":"Ueki","year":"1997","journal-title":"Eur. Respir. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1164\/rccm.200303-398OC","article-title":"Function and bulk of respiratory and limb muscles in patients with cystic fibrosis","volume":"168","author":"Pinet","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1164\/rccm.200802-232OC","article-title":"Effect of systemic inflammation on inspiratory and limb muscle strength and bulk in cystic fibrosis","volume":"180","author":"Dufresne","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1590\/S1806-37562015000000266","article-title":"Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: The utility of ultrasound imaging","volume":"42","author":"Santana","year":"2016","journal-title":"J. Bras. Pneumol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Santana, P.V., Cardenas, L.Z., de Albuquerque, A.L.P., de Carvalho, C.R.R., and Caruso, P. (2019). Diaphragmatic ultrasound findings correlate with dyspnea, exercise tolerance, health-related quality of life and lung function in patients with fibrotic interstitial lung disease. BMC Pulm. Med., 19.","DOI":"10.1186\/s12890-019-0936-1"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"107293","DOI":"10.1016\/j.rmed.2023.107293","article-title":"Prevalence of diaphragm dysfunction in patients with interstitial lung disease (ILD): The role of diaphragmatic ultrasound","volume":"216","author":"Bernardinello","year":"2023","journal-title":"Respir. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"13","DOI":"10.5578\/tt.20239903","article-title":"Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes?","volume":"71","author":"Okutan","year":"2023","journal-title":"Tuberk. Toraks"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1053\/j.jvca.2020.06.013","article-title":"Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach","volume":"35","author":"Guarracino","year":"2021","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/jum.15706","article-title":"Diaphragm and Phrenic Nerve Ultrasound in COVID-19 Patients and Beyond: Imaging Technique, Findings, and Clinical Applications","volume":"41","author":"Patel","year":"2022","journal-title":"J. Ultrasound Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/tera.1420460605","article-title":"A population-based study of congenital diaphragmatic hernia","volume":"46","author":"Torfs","year":"1992","journal-title":"Teratology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1007\/s12519-023-00774-y","article-title":"Epidemiology of congenital diaphragmatic hernia among 24 million Chinese births: A hospital-based surveillance study","volume":"20","author":"Chen","year":"2024","journal-title":"World J. Pediatr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e356","DOI":"10.1542\/peds.2004-2845","article-title":"Outcomes of congenital diaphragmatic hernia: A population-based study in Western Australia","volume":"116","author":"Colvin","year":"2005","journal-title":"Pediatrics"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s10029-010-0699-3","article-title":"Bochdalek hernia in the adult: Demographics, presentation, and surgical management","volume":"15","author":"Brown","year":"2011","journal-title":"Hernia"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1007\/s00464-008-9754-x","article-title":"Presentation and management of Morgagni hernias in adults: A review of 298 cases","volume":"22","author":"Horton","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s10029-011-0851-8","article-title":"Congenital intra-thoracic kidney associated to Bochdalek hernia in an adult patient","volume":"15","author":"Ciuni","year":"2011","journal-title":"Hernia"},{"key":"ref_73","first-page":"e56950","article-title":"Displacement of Abdominal Organs Into the Thoracic Cavity: A Rare Case of Adult Bochdalek Hernia","volume":"16","author":"Hu","year":"2024","journal-title":"Cureus"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13017-017-0134-5","article-title":"Emergency surgery due to diaphragmatic hernia: Case series and review","volume":"12","author":"Testini","year":"2017","journal-title":"World J. Emerg. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3586","DOI":"10.1016\/j.injury.2022.07.002","article-title":"Current trends in the diagnosis and management of traumatic diaphragmatic injuries: A systematic review and a diagnostic accuracy meta-analysis of blunt trauma","volume":"53","author":"Reitano","year":"2022","journal-title":"Injury"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e9296","DOI":"10.1002\/ccr3.9296","article-title":"Right sided posterior diaphragmatic hernia with liver incarceration: A case report","volume":"12","author":"Alexi","year":"2024","journal-title":"Clin. Case Rep."},{"key":"ref_77","first-page":"e45","article-title":"Value of Ultrasonography in Detection of Diaphragmatic Injuries Following Thoracoabdominal Penetrating Trauma; a Diagnostic Accuracy Study","volume":"7","author":"Sharifi","year":"2019","journal-title":"Arch. Acad. Emerg. Med."},{"key":"ref_78","first-page":"484","article-title":"The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: A comparison with diagnostic laparoscopy","volume":"21","author":"Ilhan","year":"2015","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1016\/j.injury.2015.06.022","article-title":"Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography","volume":"46","author":"Yucel","year":"2015","journal-title":"Injury"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"451","DOI":"10.2214\/ajr.179.2.1790451","article-title":"Helical CT with sagittal and coronal reconstructions: Accuracy for detection of diaphragmatic injury","volume":"179","author":"Larici","year":"2002","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s10140-023-02174-1","article-title":"Diagnostic utility of multidetector CT scan in penetrating diaphragmatic injuries: A systematic review and meta-analysis","volume":"30","author":"Hassankhani","year":"2023","journal-title":"Emerg. Radiol."},{"key":"ref_82","first-page":"188","article-title":"The role of MRI in traumatic rupture of the diaphragm. Our experience in three cases and review of the literature","volume":"105","author":"Barbiera","year":"2003","journal-title":"Radiol. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"431","DOI":"10.4103\/jmas.jmas_259_21","article-title":"Can invasive diagnostic methods be reduced by magnetic resonance imaging in the diagnosis of diaphragmatic injuries in left thoracoabdominal penetrating injuries?","volume":"18","author":"Alizade","year":"2022","journal-title":"J. Minimal Access Surg."},{"key":"ref_84","first-page":"168","article-title":"Intrathoracic transverse colon and small bowel infarction in a patient with traumatic diaphragmatic hernia. Case report and review of the literature","volume":"52","author":"Abboud","year":"2004","journal-title":"J. Med. Liban."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e919442","DOI":"10.12659\/AJCR.919442","article-title":"Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature","volume":"21","author":"Shaban","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"rjae613","DOI":"10.1093\/jscr\/rjae613","article-title":"A delayed presentation of traumatic diaphragmatic hernia in a young male: A unusual case report and comprehensive review of literature","volume":"2024","author":"Suraj","year":"2024","journal-title":"J. Surg. Case Rep."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1055\/s-0036-1582256","article-title":"Primary and Secondary Tumors of the Diaphragm","volume":"64","author":"Baldes","year":"2016","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_88","first-page":"TD03","article-title":"Primary Hydatid Cyst of the Diaphragm Mimicking Diaphragmatic Tumour: A Case Report","volume":"9","author":"Kumar","year":"2015","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"599","DOI":"10.3855\/jidc.1584","article-title":"Primary hydatid disease of diaphragm with subcutenous extension","volume":"5","author":"Gumus","year":"2011","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_90","first-page":"263","article-title":"Endometriosis of Diaphragm: A Case Report","volume":"12","author":"Kaveh","year":"2018","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Naem, A., Andrikos, A., Constantin, A.S., Khamou, M., Andrikos, D., Lagan\u00e0, A.S., De Wilde, R.L., and Krentel, H. (2023). Diaphragmatic Endometriosis-A Single-Center Retrospective Analysis of the Patients\u2019 Demographics, Symptomatology, and Long-Term Treatment Outcomes. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206455"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e2019.00029","DOI":"10.4293\/JSLS.2019.00029","article-title":"Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management","volume":"23","author":"Nezhat","year":"2019","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1111\/1759-7714.13988","article-title":"Analysis of clinicopathological features of primary diaphragm tumors: A single-center study","volume":"12","author":"Guo","year":"2021","journal-title":"Thorac. Cancer"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"376","DOI":"10.4067\/S0717-95022022000200376","article-title":"Ultrasound Assessment of Diaphragm Thickness in Athletes","volume":"40","author":"Erail","year":"2022","journal-title":"Int. J. Morphol."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Pay\u00e1n-Salcedo, H.A., Arias-Coronel, F., Estela-Zape, J.L., and Serna-Orozco, M.F. (2024). Diaphragmatic Ultrasonography in Sports Performance: A Systematic Review. Life, 14.","DOI":"10.3390\/life14101250"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1007\/s00421-013-2726-4","article-title":"Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters","volume":"113","author":"Brown","year":"2013","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1111\/sms.12070","article-title":"Effects of inspiratory muscle training on exercise responses in Paralympic athletes with cervical spinal cord injury","volume":"24","author":"West","year":"2014","journal-title":"Scand. J. Med. Sci. Sports"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/2\/239\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:27:30Z","timestamp":1760027250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/2\/239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,5]]},"references-count":97,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["life15020239"],"URL":"https:\/\/doi.org\/10.3390\/life15020239","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,5]]}}}