We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Diaphragm injury
From WikEM
Contents
Background
- Associated with penetrating or blunt trauma to lower chest/upper abdomen
- If missed, can lead to herniation of viscera and tension enterothorax
- Most commonly left sided
- Majority will have other injuries which can mask symptoms of diaphragm injury
Clinical Features
- Pain
- Shortness of breath
- Diminished breath sounds on side of rupture
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- CXR may show visceral herniation
- CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) [1]
- MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear
- Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries)
Management
- Surgery is required to fix the defect
Disposition
- Admit
See Also
References
- ↑ Yucel, M et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015 Sep;46(9):1734-7.
