Diaphragmatic trauma

(Redirected from Diaphragmatic injury)

Background

Diaphragm anatomy from inferior view.
Left pleura cavity and diaphram (viewed from left).
  • Associated with penetrating or blunt trauma to lower chest/upper abdomen
    • ~65% from penetrating, 35% from blunt[1]
  • 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 of diaphragmatic rupture with spleen herniation.
Coronal reformatted CT image shows constriction of the herniated stomach at the level of a ruptured diaphragm (collar sign) after blunt trauma.
CT showing left hemidiaphragmatic rupture with a "dangling diaphragm sign and herniation of the stomach (confirmed on surgery).
  • CXR may show visceral herniation
    • Poorly sensitive
  • CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) [2]
    • "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. National Trauma Data Base. American College of Surgeons 2000-2004. https://ntdbdatacenter.com/ (Accessed on January 01, 2021).
  2. 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.