Diaphragmatic trauma: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Pain | *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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==Evaluation== | ==Evaluation== | ||
*CXR may show visceral herniation | *[[CXR]] may show visceral herniation | ||
*CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) <ref> 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. </ref> | *CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) <ref> 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. </ref> | ||
*MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear | *MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear | ||
Revision as of 11:44, 27 April 2017
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
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- CXR may show visceral herniation
- CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) [1]
- 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)
Management
- Surgery is required to fix the defect
Disposition
- Admit
See Also
References
- ↑ 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.