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Traumatic diaphragmatic injuries in infants and children: imaging findings
B Z Koplewitz1, C Ramos, D E Manson
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Traumatic diaphragmatic injuries (DI) in children are rare but serious. Early diagnosis using chest X-rays and advanced imaging is crucial for prompt repair and improved outcomes in pediatric patients.
Area of Science:
- Pediatric Trauma Surgery
- Diagnostic Imaging in Pediatrics
- Thoracic Surgery
Background:
- Traumatic diaphragmatic injuries (DI) in children are uncommon.
- These injuries are frequently associated with severe, life-threatening trauma.
- Delayed diagnosis of DI can lead to critical complications like organ herniation.
Purpose of the Study:
- To present the imaging findings in a pediatric population with traumatic diaphragmatic injuries.
- To highlight the diagnostic challenges and outcomes of DI in children.
- To emphasize the importance of early recognition and management.
Main Methods:
- Retrospective review of medical records for pediatric patients with DI from 1977 to 1998.
- Analysis of imaging, clinical, surgical, and autopsy findings.
- Inclusion of 16 pediatric patients diagnosed with diaphragmatic injuries.
Main Results:
- 14 of 16 patients sustained blunt trauma; 2 had penetrating injuries.
- Associated injuries were common (81%), including head trauma and visceral injuries.
- Chest X-ray suggested DI in 81% of cases; CT showed diaphragm abnormalities in 4/7 patients.
- Mortality rate was 37.5% (6/16 patients) due to complications.
Conclusions:
- Plain film radiography is often sufficient to suggest the diagnosis of diaphragmatic injury.
- CT and MRI serve as valuable adjuncts for diagnosis.
- A high index of suspicion and understanding injury mechanisms are key for prompt diagnosis, repair, and reduced morbidity/mortality.
Objectives:
Traumatic diaphragmatic injuries (DI) in infants and children are uncommon and are often associated with multiple severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. We present the imaging findings in a relatively large population of children who experienced this rare injury.
Methods:
Medical records of all patients admitted to our Trauma Service from 1977 to 1998 with DI were retrospectively reviewed recording imaging, clinical and surgical or autopsy findings.
Results:
Of sixteen patients with DI (7 females, 9 males; age 3 weeks to 15 years), 14 suffered from blunt trauma secondary to high-energy impact, and 2 from penetrating injuries. Unilateral DI occurred equally on each side, with one bilateral injury. Associated injuries, present in 81%, included severe head injuries, visceral, mesenteric and vascular injuries and multiple fractures. Six patients died from multiple organ failure (3), head injury (2), and shock (1). Findings in the initial chest X-ray suggested the diagnosis in 13 (81%) of 16 injuries, and CT demonstrated irregularity and thickening of the diaphragm in 4 out of 7.
Conclusions:
Plain film findings suggested the diagnosis in most; CT and MR were useful adjuncts. High index of suspicion and awareness of the mechanism of injury can lead to prompt diagnosis, early repair, and decreased morbidity and mortality.
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