Diaphragmatic trauma: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*[[CXR]] may show visceral herniation | *[[CXR]] may show visceral herniation | ||
**Poorly sensitive | |||
*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> | ||
**"Collar sign" | **"Collar sign" | ||
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*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 | ||
*Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries) | *Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries) | ||
*Thoracoscopy | |||
*Laparoscopy | |||
==Management== | ==Management== | ||
Revision as of 00:37, 12 July 2018
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
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
- 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
- "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
- 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.