Diaphragm injury

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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

Clinical Features

  • Pain
  • Shortness of breath
  • Diminished breath sounds on side of rupture

Differential Diagnosis

Thoracic Trauma

Evaluation

  • CXR may show visceral herniation
  • CT chest/abdomen/pelvis with contrast may better detect smaller herniations (but not 100% sensitive)
  • MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear
  • Surgical exploration is ultimately the best diagnostic modality

Management

  • Surgery is required to fix the defect

Disposition

  • Admit

See Also

References