A 23-Year-Old Man With Dyspnea During Myasthenia Crisis

Weinberg, Monica; Cavalcante, James A.; Choy, Terence; Ahmad, Sahar

doi:10.1016/j.chest.2018.10.054

Cited by 1 publication

(2 citation statements)

References 8 publications

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“…26 Another case report showed that DUS could provide dynamic information regarding the diaphragm to identify the need for mechanical ventilation in myasthenic crisis. 27 Therefore, dynamic assessment of diaphragm involvement is of considerable importance in the early recognition of respiratory muscle fatigue and evaluation of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Ashraf and Vayzband reported an 81‐year‐old female who presented with myasthenic crisis with normal vital capacity throughout the course of her hospitalization, which emphasized the limitations of pulmonary function tests and the importance of monitoring respiratory status in patients related to clinical context 26 . Another case report showed that DUS could provide dynamic information regarding the diaphragm to identify the need for mechanical ventilation in myasthenic crisis 27 . Therefore, dynamic assessment of diaphragm involvement is of considerable importance in the early recognition of respiratory muscle fatigue and evaluation of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Diaphragmatic ultrasonography as a predictor of respiratory muscle fatigue in myasthenia gravis

Ma,

Zhang,

Pang

et al. 2023

Muscle and Nerve

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Introduction/AimsEasy fatigability, the clinical hallmark of generalized myasthenia gravis (GMG), cannot be detected in a dynamic way. The aim of this study was to assess respiratory function dynamically through diaphragmatic ultrasonography (DUS) in GMG patients.MethodsGMG patients and controls were recruited in a 1:1 ratio. DUS was performed during one quiet breath and 15 consecutive deep breaths. The diaphragm thicknesses were measured at different positions. Diaphragm thickening fraction (TFdi) and the maximal change in diaphragm thickness (Tmax) during 15 consecutive deep breaths were calculated and transformed to normality, named N‐TFdi and N‐Tmax, respectively. The percentages of changes in TFdi and Tmax compared with baseline were named ΔTFdi and ΔTmax, respectively. The diagnostic parameter for respiratory muscle fatigue was chosen from ΔTFdi and ΔTmax at different deep breath times according to their ability to distinguish GMG patients from controls and the interrater reliability of TFdi and Tmax.ResultsThirty‐four GMG patients and 30 healthy controls were enrolled. N‐TFdi and N‐Tmax significantly changed as the number of deep breaths increased (p < .001) in GMG patients, but not in controls. ΔTmax of the 15th deep breath (ΔTmax15) was selected as the diagnostic parameter for respiratory muscle fatigue. There were no significant differences in percentage of predicted values of forced vital capacity and arterial partial pressure of carbon dioxide between patients with normal and abnormal ΔTmax15.DiscussionDUS could identify diaphragm fatiguability in GMG patients, which may be more reliable and sensitive in assessment of diaphragm fatigue than conventional methods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%