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Diaphragmatic Paralysis: Background, Pathophysiology, Etiology - Medscape Miller JM, Moxham J, Green M. The maximal sniff in the assessment of diaphragm function in man. 2023 Saint Johns Cancer Institute. 2002 Jul;42(7):635-8. Fluoroscopic examination of the diaphragm ("sniff test") is very useful in diagnosing diaphragmatic paralysis. The diagnosis of paralysis requires observing quiet and deep inspiration. Harriet Paltiel. The decrease may not be as easy to detect in those with unilateral diaphragm paralysis. Isolated bilateral diaphragmatic paresis with interstitial lung disease. [QxMD MEDLINE Link]. Ann Thorac Surg. [QxMD MEDLINE Link]. 7. Valls-Sol J, Solans M. Idiopathic bilateral diaphragmatic paralysis. The thickening fraction of the intercostal muscles as an index of diaphragmatic dysfunction and the use of accessory muscles has a linear, negative relationship with the calculated thickening index of the diaphragm, although insufficient evidence exists to advocate its routine use at this time. Because most cases of unilateral diaphragmatic paralysis are found incidentally during imaging studies, many patients have no symptoms. Versteegh MI, Braun J, Voigt PG, Bosman DB, Stolk J, Rabe KF. National Library of Medicine Summerhill EM, El-Sameed YA, Glidden TJ, McCool FD. Gurses MS, Eren F, Trkmen Inanir N, Eren B, etin S. Mehrotra AK, Vaishnav K, Gupta PR, Khublani TK, Anupam, Soni S, Feroz A. .3 After locating the muscular part of the diaphragm, the sniff test is applied, and the change in thickness of the diaphragm noted via both B-mode and M-mode ultrasonography. On examination, with the patient lying flat, the abdominal wall moves inward during inhalation (instead of the normal outward movement). Occasionally, electromyographic interrogation of the diaphragm and phrenic nerve is done, but carrying out and interpreting the results of this test require considerable expertise, and the diagnostic accuracy of the test is uncertain. The fluoroscopic sniff test, also known as diaphragm fluoroscopy, is a quick and easy real time fluoroscopic assessment of diaphragmatic motor function (excursion). 99(6):1386-93. 155(5):1570-4. MIP is the pressure generated during maximal inspiratory effort against a closed system. Less than 20% thickening of the diaphragm muscle during inspiration is diagnostic of diaphragmatic paralysis.