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Related Experiment Videos

Blunt diaphragm injuries. A five-year experience.

G R Voeller1, J R Reisser, T C Fabian

  • 1Department of Surgery, University of Tennessee, Memphis.

The American Surgeon
|January 1, 1990
PubMed
Summary

Blunt diaphragmatic injuries from vehicle accidents are serious. Chest X-rays are the most beneficial diagnostic tool, though combining them with diagnostic peritoneal lavage improves accuracy for these traumatic injuries.

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Area of Science:

  • Trauma Surgery
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Blunt diaphragmatic injuries are often associated with high-energy trauma, primarily motor-vehicle accidents.
  • These injuries present diagnostic challenges, with potential for delayed identification and significant morbidity.
  • Associated injuries, particularly intra-abdominal, are common and complicate management.

Purpose of the Study:

  • To evaluate the diagnostic modalities for blunt diaphragmatic injuries.
  • To assess the effectiveness of various imaging techniques and procedures.
  • To identify factors influencing diagnosis and outcomes in patients with diaphragmatic rupture.

Main Methods:

  • Retrospective review of 33 patients treated for blunt diaphragmatic injuries between 1983 and 1988.

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  • Analysis of diagnostic methods including chest X-ray, diagnostic peritoneal lavage (DPL), CT scan, and barium enema.
  • Correlation of diagnostic findings with injury characteristics and patient outcomes.

    • Main Results:

    • Chest X-ray was abnormal in most patients and diagnostic in 27%, particularly for right-sided injuries (78%).
    • Diagnostic peritoneal lavage (DPL) showed a high rate of false negatives for isolated diaphragm injuries.
    • CT scans and barium enema were not diagnostic in the limited cases reviewed.
    • Delayed diagnosis occurred in four patients, with repeat imaging or lavage eventually confirming the injury.

    Conclusions:

    • Chest X-ray is the most beneficial single diagnostic test for diaphragmatic injury.
    • Diagnostic peritoneal lavage (DPL) is insensitive for isolated diaphragm injuries, but its combination with chest X-ray aids diagnosis.
    • Ancillary radiologic tests provided limited benefit; an elevated or obscured right hemidiaphragm warrants suspicion for rupture.