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Cryptogenic organising pneumonia — SCE Respiratory MCQ

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HardILDCryptogenic organising pneumoniaSCE Respiratory

After cardiac surgery, a patient develops orthopnoea and elevation of the right hemidiaphragm. On M-mode ultrasound during a brisk sniff, which finding most strongly supports right hemidiaphragm paralysis?

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Correct answer: E — Absent or paradoxical cranial right excursion during the sniff manoeuvre

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

D is correct. A paralysed hemidiaphragm lacks normal caudal inspiratory excursion and may move paradoxically cranially when negative intrathoracic pressure is generated during a voluntary sniff; M-mode ultrasound can demonstrate the direction and magnitude. Preserved caudal descent and thickening argue against paralysis. Contralateral changes do not establish right phrenic dysfunction, and bilateral normal descent on supine loading is not a paralytic pattern. Quiet breathing and deep inspiration should also be reviewed because sniff performance can occasionally mislead.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC7909996/