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Hassankhani A, Amoukhteh M, Valizadeh P, Jannatdoust P, Eibschutz LS, Myers LA, Gholamrezanezhad A. Diagnostic utility of multidetector CT scan in penetrating diaphragmatic injuries: A systematic review and meta-analysis. Emerg Radiol 2023; 30:765-776. [PMID: 37792116 PMCID: PMC10695863 DOI: 10.1007/s10140-023-02174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
Penetrating diaphragmatic injuries pose diagnostic and management challenges. Computed tomography (CT) scans are valuable for stable patients, but concern exists for missed injuries and complications in nonoperatively managed cases. The objective of this study was to explore the diagnostic utility of multidetector CT scan (MDCT) in identifying diaphragmatic injuries resulting from penetrating trauma. A systematic review and meta-analysis were conducted, following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to July 6, 2023. Eligible studies reporting MDCT's diagnostic accuracy in detecting penetrating diaphragmatic injuries were included. Relevant data elements were extracted and analyzed using STATA software. The study included 9 articles comprising 294 patients with confirmed penetrating diaphragmatic injuries through surgical procedures. MDCT's diagnostic performance revealed a pooled sensitivity of 74% (95% CI: 56%-87%) and a pooled specificity of 92% (95% CI: 79%-97%) (Fig. two), with significant heterogeneity in both sensitivity and specificity across the studies. The Fagan plot demonstrated that higher pre-test probabilities correlated with higher positive post-test probabilities for penetrating diaphragmatic injury diagnosis using MDCT, but even with negative results, there remained a small chance of having the injury, especially in cases with higher pre-test probabilities. This study highlights MDCT's effectiveness in detecting diaphragmatic injury from penetrating trauma, with moderate to high diagnostic accuracy. However, larger sample sizes, multicenter collaborations, and prospective designs are needed to address observed heterogeneity, enhancing understanding and consistency in MDCT's diagnostic capabilities in this context.
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Affiliation(s)
- Amir Hassankhani
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melika Amoukhteh
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Jannatdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Liesl S Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA
| | - Lee A Myers
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA.
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Hettiarachchi M, Thalgahagoda S. Delayed presentation of traumatic right diaphragmatic hernia of a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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3
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İlhan M, Alizade E, Durak G, Kaan Gok A, Ertekin C. Can invasive diagnostic methods be reduced by magnetic resonance imaging in the diagnosis of diaphragmatic injuries in left thoracoabdominal penetrating injuries? J Minim Access Surg 2022; 18:431-437. [PMID: 35708387 PMCID: PMC9306128 DOI: 10.4103/jmas.jmas_259_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cremonini C, Lewis MR, Jakob D, Benjamin ER, Chiarugi M, Demetriades D. Diagnosing penetrating diaphragmatic injuries: CT scan is valuable but not reliable. Injury 2022; 53:116-121. [PMID: 34607700 DOI: 10.1016/j.injury.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/25/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The diagnosis of penetrating isolated diaphragmatic injuries can be challenging because they are usually asymptomatic. Diagnosis by chest X-ray (CXR) is unreliable, while CT scan is reported to be more valuable. This study evaluated the diagnostic ability of CXR and CT in patients with proven DI. METHODS Single center retrospective study (2009-2019), including all patients with penetrating diaphragmatic injuries (pDI) documented at laparotomy or laparoscopy with preoperative CXR and/or CT evaluation. Imaging findings included hemo/pneumothorax, hemoperitoneum, pneumoperitoneum, elevated diaphragm, definitive DI, diaphragmatic hernia, and associated abdominal injuries. RESULTS 230 patients were included, 62 (27%) of which had isolated pDI, while 168 (73%) had associated abdominal or chest trauma. Of the 221 patients with proven DI and preoperative CXR, the CXR showed hemo/pneumothorax in 99 (45%), elevated diaphragm in 51 (23%), and diaphragmatic hernia in 4 (1.8%). In 86 (39%) patients, the CXR was normal. In 126 patients with pDI and preoperative CT, imaging showed hemo/pneumothorax in 95 (75%), hemoperitoneum in 66 (52%), pneumoperitoneum in 35 (28%), definitive DI in 56 (44%), suspected DI in 26 (21%), and no abnormality in 3 (2%). Of the 57 patients with isolated pDI the CXR showed a hemo/pneumothorax in 24 (42%), elevated diaphragm in 14 (25%) and was normal in 24 (42%). CONCLUSIONS Radiologic diagnosis of DI is unreliable. CT scan is much more sensitive than CXR. Laparoscopic evaluation should be considered liberally, irrespective of radiological findings.
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Affiliation(s)
- Camilla Cremonini
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA; General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy.
| | - Meghan R Lewis
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Dominik Jakob
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Elizabeth R Benjamin
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy.
| | - Demetrios Demetriades
- Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA.
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Yucel M, Yildiz A. Leukocytes are not Reliable in Predicting Possible Diaphragmatic Injury in Patients with Penetrating Left Thoracoabdominal Stab Wounds. World J Surg 2021; 45:3027-3030. [PMID: 34160655 DOI: 10.1007/s00268-021-06212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diaphragm is injured in approximately one-third of penetrating left thoracoabdominal stab wounds. Diagnostic laparoscopy or thoracoscopy is performed to reveal the diaphragmatic injury. This study investigated whether leukocytes, leukocyte subgroups, platelets, the neutrophil-to-lymphocyte ratio (NLR), and the thrombocyte-to-lymphocyte ratio (PLR) can be used to detect diaphragm injury without the need for diagnostic laparoscopy. METHODS Patients hospitalized between January 2010 and January 2020 due to penetrating left thoracoabdominal stab wounds were examined. Laparotomy was performed in patients who had indications for laparotomy, such as hemodynamic instability and peritonitis. Diagnostic laparoscopy was performed to reveal possible diaphragmatic injury in patients who did not require laparotomy after 48h of follow-up. Leukocytes, leukocyte subgroups, platelets, NLR, and PLR were measured both at admission and during follow-up, and the results were compared between patients with and without diaphragm injury during diagnostic laparoscopy. RESULTS The study included 108 patients with penetrating left thoracoabdominal stab wounds that did not require laparotomy after 48h of follow-up. Of these, 102 patients were male (94.44%), and the average age was 27.68 years (range 15-66 years). Diaphragm injury was detected in 31 patients (28.70%) in diagnostic laparoscopy, and the diaphragm was intact in 77 patients (71.30%). In the comparison of patients with and without diaphragmatic injury, no statistically significant difference was found in terms of age, gender, platelets, leukocyte values, NLR, and PLR both at admission and during follow-up. CONCLUSIONS Leukocytes, leukocyte subsets, platelets, NLR, and PLR were insufficient in the detection of asymptomatic diaphragmatic injuries caused by penetrating left thoracoabdominal stab wounds.
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Affiliation(s)
- Metin Yucel
- Department of General Surgery, Umraniye Training and Research Hospital, Adem Yavuz street No. 1, Umraniye, Istanbul, Turkey.
| | - Abdullah Yildiz
- Department of General Surgery, Umraniye Training and Research Hospital, Adem Yavuz street No. 1, Umraniye, Istanbul, Turkey
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Conti L, Grassi C, Delfanti R, Cattaneo GM, Banchini F, Capelli P. Left diaphragmatic rupture in vehicle trauma: Report of surgical treatment and complications of two consecutive cases. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021121. [PMID: 33944817 PMCID: PMC8142760 DOI: 10.23750/abm.v92is1.10931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Diaphragmatic ruptures are associated with blunt abdominal or thoracic trauma and often occur in car and motorbike accident with a high energy impact. CASE PRESENTATION We report two cases of patients victims of car and motorbike accidents that were referred to the Emergency Department of our Hospital in August and September 2017 for a politrauma. The patients were both diagnosed with a left diaphragmatic rupture with herniation of the stomach in the chest, and decomposed fractures of the ribs. One of the two patients reported a large abdominal wound with loss of substance in the site of the impact. Both patients underwent to open emergency surgery with primary repair of the phrenic rupture. The post-operative course was characterized by the occurrence of complications such as respiratory distress and emothorax for one of the patients. CONCLUSION Traumatic rupture of the diaphragm can be associated to blunt or penetrating abdominal trauma in car and motorbike accident with a prevalence of the left-sided lesions. In patients with politrauma an associate rupture of the diaphragm should be always suspected especially in motor accident where high energy impact can generate a traumatic laceration of the respiratory muscle. The treatment of associate thoracic wall fractures to prevent weaning and respiratory distress in intubated patient should be discussed.
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Affiliation(s)
- Luigi Conti
- Department of Surgery, G. Da Saliceto Hospital, Piacenza.
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Deng X, Deng Z, Huang E. Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades. BMC Surg 2021; 21:142. [PMID: 33740945 PMCID: PMC7980578 DOI: 10.1186/s12893-021-01141-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990–2005, 2005–2017) divided by introduction of computed tomography at our institution. Results The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005–2017) yet none in the first group (1990–2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. Conclusions High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.
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Affiliation(s)
- Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, No. 86 Ziyuan Road, Changsha, 410007, Hunan, China.
| | - Zuosheng Deng
- Department of Cardiothoracic Surgery, First People's Hospital of Chenzhou, Chenzhou, 423000, Hunan, China.
| | - Erjia Huang
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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Vempalli N, Konda SR, Kaeley N, Bhardwaj BB, Kumar S. Post-traumatic diaphragmatic hernia: Diagnostic dilemma in primary care. J Family Med Prim Care 2020; 9:2555-2557. [PMID: 32754545 PMCID: PMC7380781 DOI: 10.4103/jfmpc.jfmpc_160_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/16/2022] Open
Abstract
Diaphragmatic hernia (DH) is a common condition following blunt trauma to upper abdomen and is also a commonly missed diagnosis. Its early anticipation in post-traumatic setting is very important to avoid any further life-threatening sequelae. X-ray chest with a nasogastric tube is a simpler way to diagnose this condition. CT scan is a gold standard tool to confirm diagnosis. Due to wide availability of ultrasound (US) in emergency room (ER), this tool will decide the correct way of further evaluation avoiding unnecessary delays in management. We present a case of a diaphragmatic hernia followed by blunt injury abdomen with multiple herniated abdominal contents successfully managed by early intervention.
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Affiliation(s)
- Nagasubramanyam Vempalli
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sireesha Reddy Konda
- Department of Plastic Surgery, Himalayan Institute of Medical Sciences, Jolly Grant, Uttarakhand, India
| | - Nidhi Kaeley
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bharat B Bhardwaj
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Subodh Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Angelou VN, Patsikas MN, Kazakos GM, Tragoulia I, Paraskevas GK, Theodoridis TD, Ilia GM, Koutsouflianiotis K, Ilia TSM, Tselepidis S, Papazoglou LG. Bilothorax Associated with Bile Peritonitis in a Dog with No Diaphragmatic Disruption: A Case Report. Top Companion Anim Med 2020; 40:100453. [PMID: 32690288 DOI: 10.1016/j.tcam.2020.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
A 4-year-old intact male mixed-breed dog was presented with vomiting and severe depression of 6-day duration after being struck by a car 2 weeks before presentation. Clinical examination revealed hypothermia, respiratory difficulty, jaundice, and a bicavitary (pleural and peritoneal) effusion. Hematological and biochemical abnormalities included neutrophilic leukocytosis, increased total bilirubin concentration, and increased serum lipase activity. Biochemical and cytological evaluation of both abdominal and thoracic fluids were suggestive of bilious effusions. During celiotomy, a rupture of the cystic duct was observed, which necessitated cholecystectomy. A diaphragmatic rupture was not found. A thoracostomy tube was inserted in the right pleural space, and continuous suction was maintained for 48 hours. The dog was discharged 20 days after surgery and no abnormalities were detected on either blood tests or ultrasonographic examinations of the thorax and abdomen on follow-up examination 7 months after surgery. The presence of a bilothorax should be considered in animals with bile peritonitis, grossly intact diaphragm and pleural effusion. The exact mechanisms of the development of bilothorax are unclear, but the transport of bile through microscopic congenital or acquired weaknesses or defects of the diaphragm, via abdominal lymphatics penetrating the diaphragm and draining into the thoracic lymphatics represent the most probable route.
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Affiliation(s)
- Vasileia N Angelou
- Department of Clinical Studies, School of Veterinary Medicine, AUT, Greece
| | - Michail N Patsikas
- Department of Clinical Studies, School of Veterinary Medicine, AUT, Greece.
| | - George M Kazakos
- Department of Clinical Studies, School of Veterinary Medicine, AUT, Greece
| | - Ioanna Tragoulia
- Department of Clinical Studies, School of Veterinary Medicine, AUT, Greece
| | | | | | - Georgia M Ilia
- Department of Surgery, Agios Dimitrios General Hospital, Thessaloniki, Greece
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Nummela MT, Thorisdottir S, Oladottir GL, Koskinen SK. Imaging of penetrating thoracic trauma in a large Nordic trauma center. Acta Radiol Open 2020; 8:2058460119895485. [PMID: 31903225 PMCID: PMC6926989 DOI: 10.1177/2058460119895485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background Penetrating trauma is rarely encountered in Nordic trauma centers, yet the incidence is increasing. Typical imaging findings in penetrating trauma should thus be familiar to all radiologists. Purpose To evaluate incidence and imaging findings of penetrating chest trauma, gunshot wound (GSW) and stab wound (SW) injury spectrum, imaging protocols, and outcome in a large trauma center. Material and Methods Trauma registry data from 2013–2016 was retrieved, and imaging accessed through hospital PACS. Retrieved variables included age, gender, injury severity scores, mechanism of injury, time to CT, and 30-day mortality. Depth of thoracic, pulmonary, abdominal and skeletal injury, active bleeding, and use of chest tubes were evaluated. Results Of 636 patients with penetrating injuries, 443 (69.7%) underwent imaging. Of these, 161 (36.3%) had penetrating thoracic injuries. Of 161 patients with penetrating chest trauma in imaging, 151 (93.8%) were men (mean age = 34.9 years) and 10 (6.2%) were women (mean age = 40.7 years). The majority of patients had SWs (138 SW vs. 15 GSW). Patients with GSWs were more severely injured (mean ISS 17.00 vs. 8.84 [P=0.0014] and ISS≥16 in 53.3% vs. 16.7%) than SW patients. In CT, intrathoracic injuries were found in 49.4% (77/156) and active bleeding in 26.3% (41/156). Emergency surgery was performed in 6.2% (10/161) with postoperative CT imaging. Thirty-day mortality rate was 1.2% (2/161). Conclusion Penetrating thoracic trauma often violates intrathoracic structures and nearby compartments. Arterial phase whole-body CT is recommended as multiple injuries and active bleeding are common. CT after emergency surgery is warranted, especially to assess injuries outside the surgical field.
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Affiliation(s)
- Mari T Nummela
- HUS Medical Imaging, Töölö Trauma Center, Helsinki University Hospital, Helsinki, Finland
| | - Sigurveig Thorisdottir
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gudrun L Oladottir
- Functional Unit for Musculoskeletal Radiology, Function Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division for Radiology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
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Fleischl W, Lim YK, Wickremesekera SK. Spontaneous but delayed case of transdiaphragmatic intercostal hernia. ANZ J Surg 2019; 90:1190-1192. [PMID: 31742856 DOI: 10.1111/ans.15521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- William Fleischl
- Department of General Surgery, Wellington Hospital, Wellington, New Zealand
| | - Yu Kai Lim
- Department of General Surgery, Wellington Hospital, Wellington, New Zealand
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12
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Mirfazaelian H, Eftekhari M, Mohammadian S. An Unusual Cause of Intestinal Obstruction. J Emerg Med 2019; 58:117-118. [PMID: 31744707 DOI: 10.1016/j.jemermed.2019.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Hadi Mirfazaelian
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Eftekhari
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Mohammadian
- Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Okyere I, Okyere P, Glover PSK. Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases. Pan Afr Med J 2019; 33:256. [PMID: 31692849 PMCID: PMC6814919 DOI: 10.11604/pamj.2019.33.256.17061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 07/07/2019] [Indexed: 11/11/2022] Open
Abstract
A rare case series of traumatic right diaphragmatic rupture with hepatothorax in Ghana is reported. The first case involved a middle-aged man who sustained a penetrating chest injury following an unprovoked attack by a wild bull. The second case was a young woman who sustained a blunt chest injury after being knocked down by a moving vehicle whiles crossing the road. Both presented with ruptured right diaphgramatic rupture and had to undergo repair through thoracotomy after stabilization and the two had been well one year after surgery without any complications or sequelae.
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Affiliation(s)
- Isaac Okyere
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Perditer Okyere
- The Renal Unit, Department of Internal Medicine, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Singh D, Aggarwal S, Vyas S. Laparoscopic repair of recurrent traumatic diaphragmatic hernia. J Minim Access Surg 2019; 16:166-168. [PMID: 31031316 PMCID: PMC7176003 DOI: 10.4103/jmas.jmas_298_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic repair of recurrent diaphragmatic hernia is infrequently reported. We report successful laparoscopic management of such a case in a 23-year-old male who presented with recurrent vomiting and hiccoughs. He had suffered a gun-shot injury to the chest 2 years ago, following which a primary diaphragmatic repair was done by laparotomy and thoracotomy. The patient developed recurrent left diaphragmatic hernia, which was repaired using polypropylene mesh using a laparoscopic approach. At 6 months of follow-up, the patient is doing well, and his symptoms have resolved. Laparoscopic repair of recurrent diaphragmatic hernia is feasible.
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Affiliation(s)
- Devender Singh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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15
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Garcia LDS, Melo ASAD, Cañete LAQ. Traumatic rupture of the diaphragm with pericardial diaphragmatic hernia. Radiol Bras 2018; 51:347-348. [PMID: 30369673 PMCID: PMC6198840 DOI: 10.1590/0100-3984.2017.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Thoracic injury results from penetrating and blunt trauma and is a major contributor to overall trauma morbidity and mortality in the United States. Modern imaging algorithms utilize ultrasound, chest radiograph, and computed tomography with intravenous contrast to accurately diagnose and effectively treat patients with acute thoracic trauma. This review focuses on the etiologies, signs and symptoms, imaging, and management of several life-threatening thoracic injuries including tracheobronchial rupture, pulmonary parenchymal injury, hemothorax, pneumothorax, diaphragmatic rupture, and axial skeleton injury.
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Affiliation(s)
- Alex Newbury
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Jon D Dorfman
- Department of Surgery University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Hao S Lo
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA.
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D'Souza N, Clarke D, Laing G. Prevalence, management and outcome of traumatic diaphragm injuries managed by the Pietermaritzburg Metropolitan Trauma Service. Ann R Coll Surg Engl 2017; 99:394-401. [PMID: 28462659 PMCID: PMC5449703 DOI: 10.1308/rcsann.2017.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This audit of traumatic diaphram injury (TDI) from a busy South African trauma service reviews the spectrum of disease and highlights current approaches to these injuries. METHODS The Pietermaritzburg Metropolitan Trauma Service (PMTS) has maintained an Electronic Surgical Registry (ESR) and a Hybrid Electronic Medical Record (HEMR) system since January 1st 2012. RESULTS A total of 105 TDIs were identified and repaired during the study period. The mean patient age was 30 years (range 15-68 years - SD 9.7). The majority (92.4%) of patients were male (97/105). Penetrating trauma was the leading mechanism of injury (94%). 75 patients sustained a TDI from a stab wound, and the remaining 24 injuries resulted from gunshot wounds. Multiple associated injuries and high morbidity was seen with right diaphragm injury, blunt trauma, gunshot wounds and chronic diaphragmatic hernias. CONCLUSIONS TDI is a fairly uncommon injury with a local incidence of 1.6%. It presents in a spectrum from the obvious to the occult. Multiple associated injuries and high morbidity occur following blunt trauma or gunshot wounds, right diaphragm injury and chronic diaphragmatic hernias. Diagnostic laparoscopy offers a diagnostic and therapeutic tool to prevent progression of occult TDI to chronic diaphragmatic hernias.
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Affiliation(s)
| | - D Clarke
- Department of General Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, University of KwaZulu'Natal, South Africa
| | - G Laing
- Department of Surgery, University of KwaZulu'Natal, South Africa
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Tension fecopneumothorax secondary to unrecognized delayed traumatic diaphragmatic hernia. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Laparoscopy for Occult Left-sided Diaphragm Injury Following Penetrating Thoracoabdominal Trauma is Both Diagnostic and Therapeutic. Surg Laparosc Endosc Percutan Tech 2016; 26:e5-8. [PMID: 26766318 DOI: 10.1097/sle.0000000000000239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The diagnosis of occult traumatic diaphragm injury (TDI) has posed a dilemma to trauma surgeons. No imaging modality can accurately and conclusively identify small defects in the integrity of the diaphragm following penetrating trauma. Diagnostic laparoscopy (DL) offers a minimally invasive method of evaluating the integrity of the diaphragm. METHODS An Electronic Surgical Registry (ESR) and a Hybrid Electronic Medical Record (HEMR) system have been maintained within the Pietermaritzburg Metropolitan Trauma Service since January 1, 2012. The study was conducted between 2 hospitals located in Pietermaritzburg, KwaZulu Natal, South Africa, namely, Greys (tertiary) and Edendale (regional). Patient data were entered into the registries at the end of patient care (discharge, interhospital transfer, or death). The registries were interrogated to retrieve all cases of DL performed for left-sided penetrating thoracoabdominal trauma. RESULTS A total of 96 patients underwent semielective DL following penetrating left-sided thoracoabdominal trauma. This included 94 stab wounds and 2 gunshot wounds. The mean patient age was 29 years (range, 15 to 68 y, SD=8.8). The majority (59/96) of patients were male. Twenty-two (23% incidence) cases of TDI were identified at DL. Eighteen (82%) were repaired laparoscopically, and the remaining 4 required conversion to laparotomy and open repair. CONCLUSIONS TDI presents in a spectrum from the obvious to the occult. Our results validate the utilization of DL as a minimally invasive intervention for both the diagnosis and repair of TDI in selected patients presenting with penetrating left-sided thoracoabdominal trauma.
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Bonatti M, Lombardo F, Vezzali N, Zamboni GA, Bonatti G. Blunt diaphragmatic lesions: Imaging findings and pitfalls. World J Radiol 2016; 8:819-828. [PMID: 27843541 PMCID: PMC5084060 DOI: 10.4329/wjr.v8.i10.819] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.
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Abdullah M, Stonelake P. Tension pneumothorax due to perforated colon. BMJ Case Rep 2016; 2016:bcr-2016-215325. [PMID: 27247208 DOI: 10.1136/bcr-2016-215325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation.
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Affiliation(s)
- Muhammad Abdullah
- Department of General Surgery, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Paul Stonelake
- Department of General Surgery, Russells Hall Hospital, Dudley, UK
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Vyas PK, Godbole C, Bindroo SK, Mathur RS, Akula B, Doctor N. Case-based discussion: an unusual manifestation of diaphragmatic hernia mimicking pneumothorax in an adult male. Int J Emerg Med 2016; 9:11. [PMID: 26924754 PMCID: PMC4770005 DOI: 10.1186/s12245-016-0108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
Diaphragmatic hernia is an important cause of emergency hospital admission associated with significant morbidity. It usually results from congenital defect or rupture in the diaphragm due to trauma. Prompt and appropriate diagnosis is necessary in patients with this condition, as surgical intervention by either abdominal or thoracic approach may be necessary. Here, we report a case of left-sided diaphragmatic hernia presenting with sudden onset of breathlessness, respiratory distress and left-sided chest pain radiating to the abdomen, mimicking pneumothorax, treated successfully with surgical intervention.
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Affiliation(s)
- Pradeep Kumar Vyas
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026.
| | - Chintamani Godbole
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
| | - Susheel Kumar Bindroo
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026
| | - Rajiv S Mathur
- Department of Emergency and Respiratory Medicine, Jaslok Hospital and Research Centre, 15 Dr. G. Deshmukh Marg, Mumbai, India, Pin-Code 91-400026
| | - Bharathi Akula
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
| | - Nilesh Doctor
- Department of Gastrointestinal-Surgery, Jaslok Hospital and Research Centre, Mumbai, India, 400 026
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Bhatt NR, McMonagle M. Recurrence in a Laparoscopically Repaired Traumatic Diaphragmatic Hernia: Case Report and Literature Review. Trauma Mon 2016; 21:e20421. [PMID: 27218049 PMCID: PMC4869421 DOI: 10.5812/traumamon.20421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/20/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022] Open
Abstract
Introduction: Traumatic diaphragmatic hernia (TDH) develops infrequently following a traumatic diaphragmatic rupture (TDR). As TDR is frequently missed due to lack of sensitive and specific imaging modalities, a high index of suspicion for such injuries is essential, whether immediately posttraumatic, or even decades after the trauma. We describe a rare case of recurrence in a laparoscopically repaired TDH and review the current literature on the same. Case Presentation: A 23-year-old male with a history of primary laparoscopic repair of left-sided TDR two years ago presented with symptoms of acute large bowel obstruction. His chest X-ray showed a left-sided pleural effusion and a loop of the bowel in the left hemithorax, but no signs of free gas. An abdominal X-ray (AXR) demonstrated massively dilated large bowel with distension of the small bowel. At laparotomy, the obstructing lesion consisted of the large bowel with omentum herniated through the left hemidiaphragm, consistent with a left recurrent/chronic diaphragmatic hernia. The diaphragmatic defect was repaired with interrupted nylon. The patient made an uneventful recovery. Conclusions: Recurrence after repair of TDH is a less reported condition (with only two published articles) and little is known regarding the factors responsible for this. Laparoscopy is an excellent diagnostic tool, but currently management is probably best performed via an open technique using heavy non-absorbable suture material to prevent recurrence. Long term follow up of these patients should also be considered.
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Affiliation(s)
- Nikita R. Bhatt
- Department of Surgery, Waterford University Hospital, Waterford, Ireland
- Corresponding author: Nikita Bhatt, Department of Surgery, Waterford University Hospital, Waterford, Ireland. Tel: +353-860609430, E-mail:
| | - Morgan McMonagle
- Department of Surgery, Waterford University Hospital, Waterford, Ireland
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Antoniou SA, Pointner R, Granderath FA, Köckerling F. The Use of Biological Meshes in Diaphragmatic Defects - An Evidence-Based Review of the Literature. Front Surg 2015; 2:56. [PMID: 26539439 PMCID: PMC4612643 DOI: 10.3389/fsurg.2015.00056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/08/2015] [Indexed: 01/30/2023] Open
Abstract
The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation.
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Affiliation(s)
- Stavros A Antoniou
- Center for Minimally Invasive Surgery, Neuwerk Hospital , Mönchengladbach , Germany ; Department of General Surgery, University Hospital of Heraklion , Heraklion , Greece
| | - Rudolph Pointner
- Department of General and Visceral Surgery, Hospital Zell am See , Zell am See , Austria
| | | | - Ferdinand Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Vivantes Hospital , Berlin , Germany
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Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury 2015; 46:1734-7. [PMID: 26105131 DOI: 10.1016/j.injury.2015.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/01/2015] [Accepted: 06/06/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Penetrating left thoracoabdominal stab injuries are accompanied by diaphragmatic injury in 25-30% of cases, about 30% of which later develop into diaphragmatic hernia. This study aimed to determine the role of multislice computed tomography in the evaluation of left diaphragm in patients with penetrating left thoracoabdominal stab wounds. MATERIALS AND METHODS This study reviewed penetrating left thoracoabdominal stab injuries managed in our clinic between April 2009 and September 2014. The thoracoabdominal region was defined as the region between the sternum, fourth intercostal space, and arcus costa anteriorly and the vertebra, lower tip of scapula, and the curve of the last rib posteriorly. Unstable cases and cases with signs of peritonitis were operated with laparotomy; the remaining patients were closely monitored. Forty-eight hours later, a diagnostic laparoscopy was applied to evaluate the left hemidiaphragma in asymptomatic patients who did not need laparotomy. The preoperatively obtained multislice thoracoabdominal computed tomography images were retrospectively examined for the presence of left diaphragm injury. Then, operative and tomographic findings were compared. RESULTS This study included a total of 43 patients, 39 (91%) males and 4 (9%) females of mean age 30 years (range 15-61 years). Thirty patients had normal tomography results, whereas 13 had left diaphragmatic injuries. An injury to the left diaphragm was detected during the operation in 9 (1 in laparotomy and 8 in diagnostic laparoscopy) of 13 patients with positive tomography for left diaphragmatic injury and 2 (in diagnostic laparoscopy) of 30 patients with negative tomography. Multislice tomography had a sensitivity of 82% (95% CI: 48-98%), a specificity of 88% (71-96%), a positive predictive value of 69% (39-91%), and a negative predictive value of 93% (78-99%) for detection of diaphragmatic injury in penetrating left thoracoabdominal stab injury. CONCLUSIONS Although diagnostic laparoscopy is the gold standard for diaphragmatic examination in patients with penetrating left thoracoabdominal stab wounds, multislice computed tomography is also valuable for detecting diaphragmatic injury.
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Kaur R, Prabhakar A, Kochhar S, Dalal U. Blunt traumatic diaphragmatic hernia: Pictorial review of CT signs. Indian J Radiol Imaging 2015; 25:226-32. [PMID: 26288515 PMCID: PMC4531445 DOI: 10.4103/0971-3026.161433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. Although many imaging techniques have proven useful for the diagnosis of blunt diaphragmatic rupture, multidetector CT (MDCT) is considered to be the reference standard for the diagnosis of diaphragmatic injury. Numerous CT signs indicating blunt diaphragmatic rupture have been described in literature with variable significance. Accurate diagnosis depends upon the analysis of all the signs rather than a single sign; however, the presence of blunt diaphragmatic rupture should be considered in the presence of any of the described signs. We present a pictorial review of various CT signs used to diagnose blunt diaphragmatic injury. Multiplanar reconstruction is very useful; however, predominantly axial sections have been described in this pictorial review as the images shown are from dual-slice CT.
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Affiliation(s)
- Ravinder Kaur
- Department of Radiodiagnosis, GMCH, Chandigarh, India
| | | | - Suman Kochhar
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Usha Dalal
- Department of General Surgery, GMCH, Chandigarh, India
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Sharp penetrating wounds: spectrum of imaging findings and legal aspects in the emergency setting. Radiol Med 2015; 120:856-65. [PMID: 26032854 DOI: 10.1007/s11547-015-0553-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
The main cause of severe civilian trauma is not the same all over the world; while in Europe the majority of cases are due to blunt traumatic injury, in the United States, penetrating gunshot wounds are the most common. Penetrating wounds can be classified into two different entities: gunshot wounds, or more technically ballistic traumas, and sharp penetrating traumas, also identifiable with non-ballistic traumas. Sharp penetrating injuries are mainly caused by sharp pointed objects such as spears, nails, daggers, knives, and arrows. The type of injuries caused by sharp pointed objects depends on the nature and shape of the weapon, the amount of energy in the weapon or implement when it strikes the body, whether it is inflicted upon a moving or a still body, and the nature of the tissue injured. In the assessment of hemodynamically stable patients with sharp penetrating wounds, the main imaging procedure is Multidetector Computed Tomography (MDCT), especially used in complicated cases of penetrating injuries with an important impact on the final therapeutic choice. The diagnostic approach has been changed by MDCT due to its technical improvements, in particular, faster data acquiring and upgraded image reconstructions.
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Horse kick related injury: Significance of the line of impact. Diagn Interv Imaging 2015; 96:503-5. [DOI: 10.1016/j.diii.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
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Diaphragmatic injuries: why do we struggle to detect them? Radiol Med 2014; 120:12-20. [DOI: 10.1007/s11547-014-0453-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/13/2014] [Indexed: 10/24/2022]
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Evolving concepts in MDCT diagnosis of penetrating diaphragmatic injury. Emerg Radiol 2014; 22:149-56. [DOI: 10.1007/s10140-014-1257-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/10/2014] [Indexed: 01/29/2023]
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Cummings KW, Javidan-Nejad C, Bhalla S. Multidetector computed tomography of nonosseous thoracic trauma. Semin Roentgenol 2014; 49:134-42. [PMID: 24836489 DOI: 10.1053/j.ro.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristopher W Cummings
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Cylen Javidan-Nejad
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Sanjeev Bhalla
- Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.
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Okur MH, Uygun I, Arslan MS, Aydogdu B, Turkoglu A, Goya C, Icen M, Cigdem MK, Onen A, Otcu S. Traumatic diaphragmatic rupture in children. J Pediatr Surg 2014; 49:420-3. [PMID: 24650469 DOI: 10.1016/j.jpedsurg.2013.11.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 11/06/2013] [Accepted: 11/12/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to describe our experience with traumatic diaphragmatic rupture (TDR). Very little has been written about this condition in the pediatric age group. METHODS Between January 2000 and December 2011, data on twenty-two patients with TDR were analyzed, and clinical data were recorded. The patients were divided into subgroups based on injury type and ISS values. RESULTS Four patients were female, and eighteen were male. Mean age was 9.4 years (range 2-15 years). TDR was left-sided in twenty (91%) patients and right-sided in two (9%). The mean ISS (Injury Severity Score) was 19 (range 11-29). No significant difference in morbidity was noted between firearm and other injuries (p=0.565) or between ISS values below and above 16 (p=0.565). Seven patients (32%) had isolated diaphragmatic injury, while the other fifteen cases had additional associated injuries. Diagnoses were determined via a chest radiograph alone in the majority of cases, while suspected cases were confirmed by multidetector computed tomography if the patients were hemodynamically stable. Herniation was observed in twenty patients. Primary suture of the diaphragm and tube thoracostomy were performed in all patients. Postoperative complications included ileus (two cases), intussusception (one case), empyema (one case), and one patient succumbed during the operation. CONCLUSIONS TDR, while uncommon, should be considered in cases of thoracoabdominal injury. All patients should undergo meticulous examination preoperatively. When the chest radiograph does not provide a definitive diagnosis, multidetector computed tomography, including multiplanar reconstruction or volume rendering, may be beneficial for confirming suspicion of diaphragmatic rupture.
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Affiliation(s)
- Mehmet Hanifi Okur
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey.
| | - Ibrahim Uygun
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
| | - Mehmet Serif Arslan
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
| | - Bahattin Aydogdu
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
| | - Ahmet Turkoglu
- Dicle University Faculty of Medicine, Department of General Surgery, 21280, Diyarbakir, Turkey
| | - Cemil Goya
- Dicle University Faculty of Medicine Department of Radiology, 21280, Diyarbakir, Turkey
| | - Mustafa Icen
- Dicle University Faculty of Medicine, Department of Emergency Medicine, 21280, Diyarbakir, Turkey
| | - Murat Kemal Cigdem
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
| | - Abdurrahman Onen
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
| | - Selcuk Otcu
- Dicle University Faculty of Medicine, Department of Pediatric Surgery, 21280, Diyarbakir, Turkey
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Hammer MM, Flagg E, Mellnick VM, Cummings KW, Bhalla S, Raptis CA. Computed tomography of blunt and penetrating diaphragmatic injury: sensitivity and inter-observer agreement of CT Signs. Emerg Radiol 2013; 21:143-9. [DOI: 10.1007/s10140-013-1166-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/04/2013] [Indexed: 12/18/2022]
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Ganie FA, Lone H, Lone GN, Wani ML, Ganie SA, Wani NUD, Gani M. Delayed presentation of traumatic diaphragmatic hernia: a diagnosis of suspicion with increased morbidity and mortality. Trauma Mon 2013; 18:12-6. [PMID: 24350143 PMCID: PMC3860644 DOI: 10.5812/traumamon.7125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/12/2013] [Accepted: 01/28/2013] [Indexed: 02/06/2023] Open
Abstract
Background Diaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality. Objectives The objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications. Patients and Methods Eleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress. Results Out of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy. Conclusions A small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.
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Affiliation(s)
- Farooq Ahmad Ganie
- Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India
- Corresponding author: Farooq Ahmad Ganie, Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India. Tel.: +94-69064259, Fax: +94-69064259, E-mail:
| | - Hafeezulla Lone
- Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India
| | - Ghulam Nabi Lone
- Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India
| | - Mohd Lateef Wani
- Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India
| | | | - Nasir-u-din Wani
- Department of Cardiovascular and Thoracic Surgery, SKIMS Soura, Srinagar, India
| | - Masaratul Gani
- Department of J and K Health Services, University of Kashmir, Kashmir, India
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Dreizin D, Borja MJ, Danton GH, Kadakia K, Caban K, Rivas LA, Munera F. Penetrating diaphragmatic injury: accuracy of 64-section multidetector CT with trajectography. Radiology 2013; 268:729-37. [PMID: 23674790 DOI: 10.1148/radiol.13121260] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To (a) determine the diagnostic performance of 64-section multidetector computed tomography (CT) trajectography for penetrating diaphragmatic injury (PDI), (b) determine the diagnostic performance of classic signs of diaphragmatic injury at 64-section multidetector CT, and (c) compare the performance of these signs with that of trajectography. MATERIALS AND METHODS This HIPAA-compliant retrospective study had institutional review board approval, with a waiver of the informed consent requirement. All patients who had experienced penetrating thoracoabdominal trauma, who had undergone preoperative 64-section multidetector CT of the chest and abdomen, and who had surgical confirmation of findings during a 2.5-year period were included in this study (25 male patients, two female patients; mean age, 32.6 years). After a training session, four trauma radiologists unaware of the surgical outcome independently reviewed all CT studies and scored the probability of PDI on a six-point scale. Collar sign, dependent viscera sign, herniation, contiguous injury on both sides of the diaphragm, discontinuous diaphragm sign, and transdiaphragmatic trajectory were evaluated for sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Accuracies were determined and receiver operating characteristic curves were analyzed. RESULTS Sensitivities for detection of PDI by using 64-section multidetector CT with postprocessing software ranged from 73% to 100%, specificities ranged from 50% to 92%, NPVs ranged from 71% to 100%, PPVs ranged from 68% to 92%, and accuracies ranged from 70% to 89%. Discontinuous diaphragm, herniation, collar, and dependent viscera signs were highly specific (92%-100%) but nonsensitive (0%-60%). Contiguous injury was generally more sensitive (80%-93% vs 73%-100%) but less specific (50%-67% vs 83%-92%) than transdiaphragmatic trajectory when patients with multiple entry wounds were included in the analysis. Transdiaphragmatic trajectory was a much more sensitive sign of PDI than previously reported (73%-100% vs 36%), with NPVs ranging from 71% to 100% and PPVs ranging from 85% to 92%. CONCLUSION Sixty-four-section multidetector CT trajectography facilitates the identification of transdiaphragmatic trajectory, which accurately rules in PDI when identified. Contiguous injury remains a highly sensitive sign, even when patients with multiple injuries are considered, and is useful for excluding PDI.
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Affiliation(s)
- David Dreizin
- Department of Radiology, University of Miami Leonard Miller School of Medicine, University of Miami Health System, Jackson Memorial Hospital, and Ryder Trauma Center, 1611 NW 12th Ave, West Wing 279, Miami FL 33136, USA
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Serra Valdés MA, Achon Polhamus M, Menéndez Villa MDL, Carnesoltas Suarez L. Traumatic diaphragmatic hernia: case report. Medwave 2013. [DOI: 10.5867/medwave.2013.02.5636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kumar S, Kumar S, Bhaduri S, More S, Dikshit P. An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report. Int J Surg Case Rep 2013; 4:446-8. [PMID: 23548705 DOI: 10.1016/j.ijscr.2013.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Post traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding. PRESENTATION OF CASE A 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment. DISCUSSION Blunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation(1) resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations. CONCLUSION In a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.
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Affiliation(s)
- Shailesh Kumar
- Department of Gen Surgery, PGIMER & Dr. RML Hospital, New Delhi, India.
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Sodhi KS, Virmani V, Sandhu MS, Khandelwal N. Multi detector CT Imaging of Abdominal and Diaphragmatic Hernias: Pictorial Essay. Indian J Surg 2012; 77:104-10. [PMID: 26139963 DOI: 10.1007/s12262-012-0736-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022] Open
Abstract
Diagnosis of abdominal wall hernia is often a clinical problem, especially in occult or in obese patients. Multidetector CT is an accurate method of detecting various types of abdominal and diaphragmatic hernias. It clearly demonstrates the anatomical sites of hernial sac, its contents and possible complications.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - Vivek Virmani
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - M S Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
| | - N Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, 160 012 India
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Wilson E, Metcalfe D, Sugand K, Sujenthiran A, Jaiganesh T. Delayed recognition of diaphragmatic injury caused by penetrating thoraco-abdominal trauma. Int J Surg Case Rep 2012; 3:544-7. [PMID: 22918082 DOI: 10.1016/j.ijscr.2012.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 07/14/2012] [Accepted: 07/29/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Penetrating trauma to the thoraco-abdomen may cause diaphragmatic injury (DI). We present a case which highlights the difficulties of recognizing DI and the limited role of multimodal diagnostic imaging. PRESENTATION OF CASE A 19 year old male presented with stab wounds to his left lateral chest wall. CT was suspicious for diaphragmatic injury but this could not be confirmed despite ultrasound and serial plain radiographs. He was discharged but re-presented with respiratory compromise and diaphragmatic herniation. DISCUSSION We review the clinical features of diaphragmatic injury after penetrating thoraco-abdominal trauma and the various imaging modalities available to clinicians. CONCLUSION A high index of suspicion must be employed for DI in the context of penetrating thoraco-abdominal trauma. Inpatient observation and laparoscopy/thoracoscopy should be considered when radiological findings are ambiguous. Front line physicians should also consider diaphragmatic herniation in stab victims who re-present with respiratory, circulatory, or gastrointestinal symptomology.
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Affiliation(s)
- Emily Wilson
- St George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom
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Abstract
The diagnosis of blunt diaphragmatic rupture (BDR) is difficult and often missed, leaving many patients with this traumatic injury at risk for life-threatening complications. The potential diagnostic pitfalls are numerous and include anatomic variants and congenital and acquired abnormalities. Chest radiography, despite its known limitations, may still be helpful in the early assessment of severe thoracoabdominal trauma and for detecting initially overlooked BDR or late complications of BDR. However, since the development of helical and multidetector scanners, computed tomography (CT) has become the reference standard; thus, knowledge of the CT signs suggestive of BDR is important for recognition of this injury pattern. A large number of CT signs of BDR have been described elsewhere, many of them individually, but the use of various appellations for the same sign can make previously published reports confusing. The systematic description and classification of CT signs provided in this article may help clarify matters and provide clues for diagnosing BDR. The authors describe 19 distinct CT signs grouped in three categories: direct signs of rupture, indirect signs that are consequences of rupture, and signs that are of uncertain origin. Since no single CT sign can be considered a marker leading to a correct diagnosis in every case of BDR, accurate diagnosis depends on the analysis of all signs present.
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Affiliation(s)
- Amandine Desir
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
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41
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Chaou CH, Lai YL, Chang YC. X-Ray Quiz: A Construction Worker with Blunt Chest Injury. HONG KONG J EMERG ME 2012. [DOI: 10.1177/102490791201900213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- CH Chaou
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Department of Emergency Medicine, No. 5, Fu Hsing Street, Kuei-Shang County, Tao-Yuan, Taiwan; and National Taiwan University, Graduate Institute of Epidemiology, College of Public Health, Taipei, Taiwan
| | - YL Lai
- Taipei Veterans General Hospital, Department of Surgery, National Yang-Ming University, Taipei, Taiwan
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Abstract
Imaging in trauma patients has dramatically evolved since the advent of computed tomography (CT), particularly multidetector CT (MDCT) technology. Axial MDCT images of the body can be acquired in seconds and shown any plane, allowing immediate viewing and interpreting. These factors make CT an invaluable means to detect many injuries not previously visible by any other noninvasive imaging techniques. Potentially subtle, but significant, thoracic injuries such as pneumothorax, haemothorax, aortic injury, sternal and spinal fractures can be detected on MDCT easily. In this article, the author will discuss the use of MDCT in the diagnosis of various thoracic injuries.
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Affiliation(s)
- R Kaewlai
- Massachusetts General Hospital, USA.
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Lasithiotakis K, Venianaki M, Tsavalas N, Zacharioudakis G, Petrakis I, Daskalogiannaki M, Chalkiadakis G. Incarcerated spontaneous transdiaphragmatic intercostal hernia. Int J Surg Case Rep 2011; 2:212-4. [PMID: 22096730 DOI: 10.1016/j.ijscr.2011.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/04/2011] [Accepted: 07/06/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Prolapse of abdominal viscera into the thoracic subcutis through the chest wall is known as transdiaphragmatic intercostal hernia (TIH). Herein, we present the first case of spontaneous TIH presenting as a thoracoabdominal emergency. PRESENTATION OF CASE A 78-year-old male presented with acute left thoracoabdominal pain following a sudden bulge at the left posterolateral chest wall corresponding to a partially reducible soft tissue mass with ecchymosis at the overlying skin. Paroxysmal cough during the last four days was also reported along with a prolonged daily application of a special tight abdominal belt that used while milking sheep. CT-scan of the abdomen showed intrathoracic proptosis of the splenic flexure through a defect of the left hemidiaphragm and subcutaneous prolapse of the herniated colon through the 7th intercostal space. On laparotomy, the herniated colon showed signs of ischemic necrosis leading to segmental colectomy followed by repair of the diaphragmatic defect. DISCUSSION The clinical diagnosis of spontaneous TIH demands very high index of suspicion and thorough patient's history. In this case the daily elevation of the intraabdominal pressure due to an abdominal milking belt might have caused gradual slimming and loosening of the diaphragm and the intercostals muscles rendering them vulnerable to sudden increases of the thoracoabdominal pressure due to violent coughing. Such a hypothesis is reasonable in the absence of traumatic injury in this patient. CONCLUSION Spontaneous TIH should be suspected in patients presenting with a sudden palpable chest wall bulge and associated thoracoabdominal symptoms in the absence of preceding injury.
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Affiliation(s)
- Konstantinos Lasithiotakis
- Department of General Surgery, University Hospital of Heraklion, Medical School of Heraklion, University of Crete, 71110 Heraklion, Crete, Greece
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Ahmed SM, Nadeem A, Pal J, Gupta R, Chauhan S. Difficult weaning in delayed onset diaphragmatic hernia. J Emerg Trauma Shock 2011; 2:132-4. [PMID: 19561975 PMCID: PMC2700598 DOI: 10.4103/0974-2700.50750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/29/2008] [Indexed: 11/04/2022] Open
Abstract
Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI) can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.
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Affiliation(s)
- Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, JN Medical College, Aligarh Muslim University, Aligarh, India
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Lal S, Kailasia Y, Chouhan S, Gaharwar A, Shrivastava G. Delayed presentation of post traumatic diaphragmatic hernia. J Surg Case Rep 2011; 2011:6. [PMID: 24950044 PMCID: PMC3649270 DOI: 10.1093/jscr/2011.7.6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in polytraumatized patients including blunt abdomino-thoracic trauma due to road traffic accidents, fall from height and penetrating injuries. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. Late presentations are associated with increased morbidity. We report an interesting case of blunt traumatic diaphragmatic hernia in a 32-year-old man presenting 4 years after the initial abdomino-thoracic injury due to fall from height. He had herniation of the spleen and stomach. Through a left sub costal incision, the herniated organs were reduced and diaphragmatic defect closed with interrupted prolene suture.
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Affiliation(s)
- S Lal
- S.S.Medical College & Asso.S.G.M.Hospital, Rewa, India
| | - Y Kailasia
- S.S.Medical College & Asso.S.G.M.Hospital, Rewa, India
| | - S Chouhan
- S.S.Medical College & Asso.S.G.M.Hospital, Rewa, India
| | - Aps Gaharwar
- S.S.Medical College & Asso.S.G.M.Hospital, Rewa, India
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Ursic C, Curtis K. Thoracic and neck trauma. Part three. Int Emerg Nurs 2010; 18:158-65. [PMID: 20542242 DOI: 10.1016/j.ienj.2008.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous parts to this series on thoracic and neck trauma discussed the anatomy and physiology of the thorax, assessment and initial nursing interventions, imaging and adjuncts to diagnosis. Part 2 describes specific chest wall and lung injuries, types of pneumothoraces and their diagnosis and management. This section, part 3 of 4, discusses other types of thoracic injuries and their management, such as trauma to the diaphragm and heart.
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Navallas M, Borruel S, Cano R, Ibáñez L. [Delayed diagnosis of a diaphragmatic hernia in a patient on mechanical ventilation]. RADIOLOGIA 2010; 52:552-5. [PMID: 20541784 DOI: 10.1016/j.rx.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/25/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
Traumatic rupture of the diaphragm is uncommon. Its early diagnosis is a challenge in diagnostic imaging. We present the case of a male multiple trauma patient in whom a left diaphragmatic hernia was discovered on weaning from mechanical ventilation 23 days after admission. We discuss the key imaging features of diaphragmatic rupture based on its physiopathology and thoracoabdominal pressure gradients. Very few cases of radiologically documented diaphragmatic hernias masked by mechanical ventilation have been reported.
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Affiliation(s)
- M Navallas
- Servicio de Radiología, Hospital 12 de Octubre, Madrid, España.
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48
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Jana M, Hari S. Traumatic diaphragmatic rupture complicated by intercostal tube insertion into the stomach. Surgery 2010; 150:570-1. [PMID: 20189621 DOI: 10.1016/j.surg.2010.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Manisha Jana
- All India Institute of Medical Sciences, New Delhi, India.
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49
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Abstract
Chronic traumatic diaphragmatic hernia is an uncommon but persistent diagnosis associated with significant morbidity and mortality. Chronic TDH describes a spectrum of disease in antecedent mechanism of injury, timing of presentation, size of diaphragmatic defect, and amount and type of tissue displaced into the chest. Multiplanar CT with coronal, sagittal, and axial reconstruction is most effective in making this diagnosis. Once diagnosed, repair should be undertaken. Although transabdominal approaches may be successful, the authors prefer an open transthoracic approach, recognizing that either approach may need to incorporate access into the other body cavity to complete the repair. Basic hernia principles apply including the construction of a tension-free repair, which may necessitate the use of prosthetics. As surgeons become increasingly comfortable with minimally invasive techniques, more chronic TDH are likely to be approached in this fashion. Finally, as much of the morbidity and mortality is associated with the catastrophic consequences of chronic TDH, vigilance needs to be applied in an attempt to diagnose and then repair TDH while in the latent stage prior to the development of the catastrophic complications that herald the obstructive stage.
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50
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Cheung WK, Ho MP, Wang KL. Massive Hiatal Hernia of Gastrointestinal Tract: A Rare Intrathoracic Gastrointestinal Disease. J Am Geriatr Soc 2009; 57:2159-61. [DOI: 10.1111/j.1532-5415.2009.02537.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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