Diaphragm Ultrasonography as an Important Aid to Diagnose Spinal Cord Injury.
However, CT of the cervical spine demonstrated anterior dislocation at the C6 level (C8 cord level). In addition, magnetic resonance imaging (MRI) with T2-weighted image revealed a vertically
spreading high intensity lesion at the C8 spinal cord level (Figure 2). Per record, on neurological examination, including manual muscle testing, the level of spinal cord impairment was considered to be around C5 (Table 1). MRI findings, which were compatible with the anterior dislocation of C6 with possible C8 spinal cord injury (Figure 2), and the neurological findings, which suggested the involvement of higher levels of spinal cord at around C5 to C8 (Table 1) thus had a discrepancy.
Few hours after the surgery, the pulmonologists were consulted as he developed further hypoxemia as well as difficulty expectorating sputum. On examination, he was in respiratory distress and was using his accessory muscles to breathe. The respiratory rate was 25 breaths per minute, pulse 49 beats per minute, the temperature 36.6 °C, and the blood pressure 124/68 mmHg. His respiration and oxygenation improved as he was suctioned multiple times by bronchoscopy.
Our case demonstrates that accurate determination of the level of spinal cord injury is of crucial importance. Assessment of diaphragm function is an important factor to assess the level of
spinal cord injury, since the phrenic nerve emanates from the C3-C5 level. In this case, diaphragm ultrasonography clearly demonstrated bilateral diaphragmatic paralysis possibly due to spinal cord injury around the C5 level, which corresponded to the neurological findings.
Pulm Res Respir Med Open J. 2016; SE(1):S27-S30. doi: 10.17140/PRRMOJ-SE-1-110