Diaphragmatic trauma: Difference between revisions

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==Background==
==Background==
*Associated with penetrating or blunt trauma to lower chest/upper abdomen
*Associated with penetrating or blunt trauma to lower [[thoracic trauma|chest]]/[[abdominal trauma|upper abdomen]]
*If missed, can lead to herniation of viscera and tension enterothorax
*If missed, can lead to herniation of viscera and tension enterothorax
*Most commonly left sided
*Most commonly left sided
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==Clinical Features==
==Clinical Features==
*Pain
*[[abdominal pain|Upper abdominal]]/[[chest pain|lower chest pain]]
*[[Shortness of breath]]
*[[Shortness of breath]]
*Diminished breath sounds on side of rupture
*Diminished breath sounds on side of rupture
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==Management==
==Management==
*NGT decompression
*[[NG tube]] decompression
*Surgery is required to fix the defect
*Surgery is required to fix the defect



Revision as of 15:25, 12 October 2019

Background

  • Associated with penetrating or blunt trauma to lower chest/upper abdomen
  • If missed, can lead to herniation of viscera and tension enterothorax
  • Most commonly left sided
  • Majority will have other injuries which can mask symptoms of diaphragm injury
  • 75% of the time occurs on the left side; the liver is protective on the right side
  • Presentation can be delayed months to years after the initial trauma

Clinical Features

Differential Diagnosis

Thoracic Trauma

Abdominal Trauma

Evaluation

  • CXR may show visceral herniation
    • Poorly sensitive
  • CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) [1]
    • "Collar sign"
      • waist-like constriction of abdominal viscera
  • MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear
  • Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries)
  • Thoracoscopy
  • Laparoscopy

Management

  • NG tube decompression
  • Surgery is required to fix the defect

Disposition

  • Admit

See Also

References

  1. Yucel, M et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015 Sep;46(9):1734-7.