Diaphragmatic injury: a method for early diagnosis

Traumatic diaphragmatic hernia, whether of blunt or penetrating etiology, is difficult to diagnose in the acute phase. The lesion is presently best diagnosed by chest X-ray, but only occasionally. Chest X-ray appears normal or nonspecific 25 to 50% of the time. For this reason, simple diagnostic technique using radiographic methodology available in emergency rooms was studied in animals in order to devise a way to diagnose this injury. Eight per cent diatrizoate meglumine and diatrizoate sodium (Renografin, Squibb) was placed into the chest or abdomen of animals with either 8-cm simulated blunt or 5-mm simulated penetrating injuries. The Renografin was infused by either a peritoneal lavage or thoracostomy catheter. Serial X-rays showed diagnostic rate of transdiaphragmatic leakage in 24 of 26 animals with blunt injury and seven of 16 animals with penetrating injury. There was no evidence of pleural, peritoneal, or pulmonary injury from the Renografin itself. It was concluded that the experimental technique may prove useful in screening or confirming traumatic diaphragmatic hernia during the acute or latent phases.