The Diagnostic Dilemma of Diaphragm Injury

Patselas, Timothy N.; Gallagher, Edgar G.
July 2002
American Surgeon;Jul2002, Vol. 68 Issue 7, p633
Academic Journal
Prompt diagnosis of acute traumatic injury to the diaphragm remains a challenge when the admission chest X-ray is unrevealing and immediate laparotomy or thoracotomy is not indicated. Diagnostic delay may contribute to significant morbidity and mortality. A retrospective review of our 15-year experience with diaphragm injury (DI) revealed 13 patients (nine male/four female; mean age, 40 ± 34 years) who sustained injuries to the left (77%) and right (23%) diaphragm respectively as a result of motor vehicle crashes (MVCs) (69%), penetrating trauma (30%), and pedestrian-versus-car accidents (1%). Nine (69%) patients with timely diagnosis of DI underwent laparotomy for suggestive chest X-rays or other indications for immediate exploration. Four (31%) patients sustaining blunt trauma had DI missed on initial evaluation; all patients had initial radiographic evaluations of the chest and abdomen which ascribed abnormalities to intrathoracic pathology. In the one-day delay the diagnosis (right sided) was made at exploratory laparotomy for persistent abdominal pain. This 74-year-old patient, who also had sustained a duodenal injury, succumbed to sepsis. In the 17-day delay the patient had two chest CT scans and multiple bronchoscopies yet failed to wean from the ventilator before exploratory laparotomy which revealed the diagnosis. The third patient sustained multiple injuries after a MVC and underwent multiple imaging studies and back stabilization before discharge. Ten years later, after multiple negative gastrointestinal workups for abdominal pain a contrast study finally diagnosed herniated transverse colon in the left chest. This patient underwent successful repair via laparotomy. The fourth delayed diagnosis was made in a 72-year-old women who had been involved in an MVC 8 years earlier and had sustained multiple back fractures. She is scheduled for exploration in the near future. DI particulary after blunt trauma and on the right side may be missed in the...


Related Articles

  • Laparoscopic Management of a Late-Diagnosed Major Diaphragmatic Rupture. Pross, M.; Manger, Th.; Mirow, L.; Wolff, S.; Lippert, H. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Apr2000, Vol. 10 Issue 2, p111 

    Reports on a case of delayed diagnosis of diaphragmatic rupture (DR) treated by minimally invasive surgery. Standard treatment of DR; Steps for the laparoscopic procedure of DR treatment.

  • A Case of Spontaneous Rupture of the Diaphragm in a Young Pregnant Female Presenting with Hydropneumothorax. RALI, PARTH; JASANI, NAMRATA; ARSHAD, HAMMAD // Connecticut Medicine;Aug2016, Vol. 80 Issue 7, p423 

    We present a case of spontaneous rupture of the diaphragm in a young pregnant female mimicking hydropneumothorax. She had a chest tube placed on admission without any improvement in her symptoms, which led to further imaging. Chest and abdomen CT after a barium swallow confirmed the clinical...

  • The Pathologic Point of View of Laparoscopic Adrenalectomy in the Era of Radiologic Imaging: A Multicenter Retrospective Study. Tonyali, Senol; atac, Fatih; Eroglu, Unsal; Yazici, Sertac; Ozden, Ender; Sozen, Sinan; Bilen, Cenk Yücel // Urologia Internationalis;Aug2016, Vol. 97 Issue 2, p173 

    Introduction/Aim: This study aimed to determine if laparoscopic adrenalectomy (LA) is feasible for the treatment of adrenal malignancies and metastasis, and to review the final pathology findings in order to clarify the indications for surgery. Materials and Method: The medical records of all...

  • Delayed cardiac perforation due to migrating pacemaker lead. Oikonomou, Anastasia; Foutzitzi, Soultana; Prassopoulos, Panos // CMAJ: Canadian Medical Association Journal;6/15/2010, Vol. 182 Issue 9, pE379 

    The article presents a reprint of the article "Delayed cardiac perforation due to migrating pacemaker lead," by Anastasia Oikonomou and colleagues, which appeared at www.cmaj.ca website. It states the case of an 84-year-old woman, who complains of chestpains and breathlessness one month after...

  • Massive "sweet" hydrothorax. Po-Jen Yang; Tsan-Hsing Liu // CMAJ: Canadian Medical Association Journal;11/23/2010, Vol. 182 Issue 17, p1883 

    The article presents the medical case of a 59-year-old woman diagnosed with large pleural effusion with mediastinal shift to the left after receiving continuous ambulatory peritoneal dialysis. It states that laboratory analysis reveals a leakage of the dialysis fluid into the pleural space, and...

  • The chest radiograph: trauma and intervention. Snaith, Beverly; Hardy, Maryann // Synergy: Imaging & Therapy Practice;Mar2012, p13 

    The article focuses on the chest radiograph, the first imaging investigation in polytrauma or thoracic that influence initial treatment as a result of some appearances in emergency environment. It mentions that the evaluation of chest radiograph in mechanism of injury and trauma that include...

  • SHROT COMMUNICATIONS. The Probability of Diaphragmatic Injury in Left Penetrating Thoracoabdominal Traumas; Thoracotomy?, Laparotomy?, Vats?, Laparoscopy? Dubus, Turkan; Celik, Gurhan; Aren, Acar; Gunes, M Emin; Topacoglu, Hakan; Ozyuvaci, Emine // International Medical Journal;Aug2014, Vol. 21 Issue 4, p436 

    Objective: In this study, we aimed to present the probability of diaphragmatic injury following left thoracoabdominal traumas, diagnostic and therapeutic considerations with retrospective analysis and latest literature review. Materials and Methods: A total of 28 patients, hospitalized in our...

  • TREATMENT FACILITIES & HOSPITALS.  // Las Vegas Business Press (10712186);2009 Book of Lists, p90 

    A list of the top treatment facilities and hospitals in Las Vegas, Nevada for 2009 ranked based on the number of local employees is presented, including the University of Medical Center, Sunrise Hospital and Saint Rose Dominican Hospitals-Siena.

  • Quality assessment and improvement: what radiologists do and think. Deitch, C.H.; Chan, W.C.; Sunshine, J.H.; Zinninger, M.D.; Cascade, P.N. // Journal of the Canadian Chiropractic Association;Mar1995, Vol. 39 Issue 1, p51 

    No abstract available.

  • Preparing For A Hospital Surgical Procedure. Spencer, Anne H. // Subconsciously Speaking;Mar/Apr1997, Vol. 12 Issue 2, p3 

    No abstract available.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics