Diaphragmatic trauma: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
Elcatracho (talk | contribs) |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Associated with penetrating or blunt trauma to lower [[thoracic trauma|chest]]/[[abdominal trauma|upper abdomen]] | *Associated with penetrating or blunt trauma to lower [[thoracic trauma|chest]]/[[abdominal trauma|upper abdomen]] | ||
**~65% from penetrating, 35% from blunt<ref>National Trauma Data Base. American College of Surgeons 2000-2004. https://ntdbdatacenter.com/ (Accessed on January 01, 2005).</ref> | |||
*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 | ||
Revision as of 16:18, 5 January 2021
Background
- 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
- Upper abdominal/lower chest pain
- Shortness of breath
- Diminished breath sounds on side of rupture
- Kehr Sign: shoulder pain from referred diaphragm pain
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter 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) [2]
- "Collar sign"
- waist-like constriction of abdominal viscera
- "Collar sign"
- 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
- ↑ National Trauma Data Base. American College of Surgeons 2000-2004. https://ntdbdatacenter.com/ (Accessed on January 01, 2005).
- ↑ 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.