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Diaphragmatic Rupture

Diaphragm Rupture


Presentation

  • We present a case of traumatic diaphragmatic rupture that presented two years after the initial thoracic injury. The patient presented with intestinal obstruction and colonic perforations.[ncbi.nlm.nih.gov]
  • We present an interesting case of traumatic diaphragmatic hernia presenting 5 years after a road traffic accident as acute abdomen and massive haematemesis due to strangulated gangrenous gastric hernia.[ncbi.nlm.nih.gov]
  • Surgical correction was indicated secondary to the symptomatic nature of the presentation. Diaphragmatic rupture may be occult and may first present during a subsequent pregnancy.[ncbi.nlm.nih.gov]
  • An evaluation of the imaging techniques used in the diagnosis of DH is presented.[ncbi.nlm.nih.gov]
  • We present the case of a 57-year-old woman who suffered a delayed presentation of a traumatic diaphragmatic rupture (TDR).[ncbi.nlm.nih.gov]
Orthopnea
  • Signs and symptoms [ edit ] Breath sounds on the side of the rupture may be diminished, respiratory distress may be present, and the chest or abdomen may be painful. [3] Orthopnea , dyspnea which occurs when lying flat, may also occur, [7] and coughing[en.wikipedia.org]
Chest Discomfort
  • These medications resulted in some improvement in her chest discomfort. She had no history of myocardial infarction or coronary disease.[appliedradiology.com]
Pelvic Mass
  • This report describes the diagnosis and management of a patient with a delayed presentation of a ruptured right hemidiaphragm after a laparotomy for a pelvic mass.[ncbi.nlm.nih.gov]
Chronic Abdominal Pain
  • A 40-year-old woman was admitted to our clinic because of chronic abdominal pain. Chest x-ray and computed tomography scan showed a migration of the large intestine into the left hemithorax.[ncbi.nlm.nih.gov]
Chest Pain
  • We present a case involving a man suffering from chest pain and with a raised left hemidiaphragm on the chest radiograph after a motor vehicle injury.[ncbi.nlm.nih.gov]
  • If there is a mass with an air-fluid level adjacent to the diaphragm on the chest radiograph in a patient who presents with sudden chest pain after violent vomiting, spontaneous rupture of the diaphragm should be suspected and multidetector CT with multiplanar[ncbi.nlm.nih.gov]
  • We present the case of a 35-year-old pregnant woman presenting an unspecific clinical picture of intense chest pain and hypoventilation at 15 weeks of pregnancy. She was diagnosed with diaphragmatic rupture complicated by a gastric rupture.[ncbi.nlm.nih.gov]
  • A 20-year-old male patient with complaints of severe chest pain, difficulty in oral feeding, and a feeling of swelling in the abdomen was admitted to the Emergency Clinic.[ncbi.nlm.nih.gov]
  • We report a case of a 22-year-old woman with EDS who presented to the Emergency Department complaining of shortness of breath and left-sided chest pain. She was ultimately found to have a spontaneous diaphragmatic rupture after forceful emesis.[ncbi.nlm.nih.gov]
Palpitations
  • A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension[ncbi.nlm.nih.gov]
  • For progressive dyspnea and palpitations caused by a large and symptomatic Morgagni hernia resulting in a right-sided enterothorax, an open tension-free mesh repair was performed.[ncbi.nlm.nih.gov]
Neglect
  • During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused herniation of the intraabdominal contents.[ncbi.nlm.nih.gov]

Workup

  • These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the workup for related symptoms.[ncbi.nlm.nih.gov]
  • Diagnostic workup raised the suspicion of a right diaphragmatic rupture that was eventually confirmed by surgery (right-sided thoracotomy).[ncbi.nlm.nih.gov]
Left Pleural Effusion
  • The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the "sinus cut-off sign" was the sole finding in one patient.[ncbi.nlm.nih.gov]
  • A computed tomography (CT) of the chest revealed a moderate left pleural effusion, compression of the left lung, and a rounded air-fluid cavity anteriorly (Figure 2A).[appliedradiology.com]
  • Axial contrast-enhanced CT image of upper abdomen reveals left pleural effusion that is abutting the herniated bowel (arrow) Click here to view Hypoattenuated hemidiaphragm and associated rib fractures: A hypoattenuated hemidiaphragm found in association[ijri.org]
X-Ray Abnormal
  • Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points Do not miss a pneumoperitoneum An obscured hemidiaphragm may be due to adjacent lung disease An abnormal diaphragm position[radiologymasterclass.co.uk]
Chest X-Ray Abnormal
  • Home » Tutorials » Chest X-ray Tutorials » Chest X-ray Abnormalities » Introduction » 1 2 3 4 5 6 7 8 9 10 11 » Conclusion Key points Do not miss a pneumoperitoneum An obscured hemidiaphragm may be due to adjacent lung disease An abnormal diaphragm position[radiologymasterclass.co.uk]

Treatment

  • We aimed to emphasize the importance of early diagnosis and treatment of traumatic diaphragmatic (TDR) rupture which is an uncommon but potentially life-threatening problem with a high incidence of associated injuries.[ncbi.nlm.nih.gov]
  • Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition.[ncbi.nlm.nih.gov]
  • Most exostoses are asymptomatic and as such require no further treatment.[ncbi.nlm.nih.gov]
  • The patient fully recovered, and the thoracic endograft showed no evidence of endoleak both 1 month and 1 year after treatment. Fourteen months after the operation, the patient is doing well.[ncbi.nlm.nih.gov]
  • In this study, we aimed to evaluate the diagnosis and treatment options for the late diagnosis of cases of right-side traumatic diaphragmatic rupture.[ncbi.nlm.nih.gov]

Prognosis

  • The accurate diagnosis and prognosis of this pathology depend on a complete knowledge of the clinical and radiological presentation.[ncbi.nlm.nih.gov]
  • Penetrating injury has a relatively better prognosis.[ncbi.nlm.nih.gov]
  • […] time, the injury is repaired during laparotomy . [9] Other injuries, such as hemothorax , may present a more immediate threat and may need to be treated first if they accompany diaphragmatic rupture. [4] Video-assisted thoracoscopy may be used. [7] Prognosis[en.wikipedia.org]
  • It may also be associated with malformations; in this event, the prognosis is more guarded than it would be otherwise. [15, 16 , 17, 18 ] The causes of unilateral diaphragmatic paralysis are many.[emedicine.medscape.com]

Etiology

  • This study aimed to examine and improve our understanding of the etiology, clinical presentation, and management of DR. This study was performed at the Emergency and General Surgery Department of Fondazione I.R.R.C.S.[ncbi.nlm.nih.gov]
  • The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients.[ncbi.nlm.nih.gov]
  • The etiological factors, management and outcomes were discussed. The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n 11) and left-sided in 83.8% (n 57).[ncbi.nlm.nih.gov]
  • Blunt trauma caused by motor vehicle accidents and penetrating trauma from gunshot and stab wounds are the major etiologic factors in most patients.[webmedcentral.com]
  • ETIOLOGY DI 0.63% National Trauma Data Bank (NTDB) 65 % Penetrating injury 35 % Blunt injury 4.[slideshare.net]

Epidemiology

  • […] herniation : organs such as the stomach that herniate into the chest cavity and may be strangulated, losing their blood supply. [3] Herniation of abdominal organs is present in 3–4% of people with abdominal trauma who present to a trauma center. [9] Epidemiology[en.wikipedia.org]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • The aim of our study was to evaluate the incidence of diaphragmatic injuries in the thoracic-abdominal trauma and discuss the epidemiology, diagnosis and treatment.[springerplus.springeropen.com]
  • Typically, the wounds are small, although occasionally a shotgun blast or an impalement causes a large defect. [3, 4 ] Epidemiology Frequency United States Development of diaphragmatic injury in blunt trauma is relatively rare; these injuries are seen[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Non-traumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known.[ncbi.nlm.nih.gov]
  • This preponderance for left-sided injuries is thought to be related to the protective effect of the bare area of the liver in contact with the diaphragm in the right thorax. 3 The pathophysiology in blunt trauma is due to the abrupt change in intraabdomonial[westjem.com]
  • Pathophysiologically, tension viscerothorax reduces venous return to the heart much like tension pneumothorax. 4 Clinically, it may be difficult to differentiate the two conditions. 5 Chest radiography remains valuable in the acute phase for the detection[annsaudimed.net]
  • It lays stress on the need to recognize the mechanisms involved in its pathophysiology as well as the diagnostic and therapeutic modalities. 2.[article.sciencepublishinggroup.com]
  • Pathophysiology Presently, 80-90% of blunt diaphragmatic ruptures result from motor vehicle crashes (MVCs). Falls and other traumatic events rarely are implicated.[emedicine.medscape.com]

Prevention

  • Diaphragmatic hernia rupture during labor is a serious but rare complication that requires emergency surgery to prevent visceral perforation and cardio-respiratory failure.[ncbi.nlm.nih.gov]
  • Insertion of a nasogastric tube was unsuccessful (completing Borchardt's diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.[ncbi.nlm.nih.gov]
  • […] causing the rupture, can also cause abdominal contents to herniate into the thoracic cavity. [7] Abdominal contents in the pleural space interfere with breathing and cardiac activity. [7] They can interfere with the return of blood to the heart and prevent[en.wikipedia.org]
  • The early use of supplemental imaging in traumatized patients reduces the chance of missed injury and prevents associated morbidity and mortality.[afrjtrauma.com]
  • However, the history of multi-trauma and the suspicion of diaphragmatic rupture prevented us from performing any invasive procedure before obtaining more imaging details.[rc.rcjournal.com]

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