Presentation
We have focussed on mechanism of injury, duration, presentation and site of injury, visceral herniation, investigations and different approaches for repair. [ncbi.nlm.nih.gov]
Respiratory distress was the presenting feature in 10 cases [ 7, 11 – 13, 17, 21, 24 ]. Abdominal pain was the presenting feature in 3 cases [ 13, 17, 18 ]. [doi.org]
Entire Body System
- Pain
Patients present with non-specific symptoms and may complain of chest pain, abdominal pain, dyspnoea, tachypnoea and cough, heartburn and symptoms of gastro-oesophageal reflux. Respiratory distress and faeco-pneumothorax have been reported. [ncbi.nlm.nih.gov]
- Collapse
A 60-year-old man suffered severe blunt trauma from heavy steel frames collapsing against his back, resulting in pelvic and femoral fractures as well as pulmonary contusions. [ncbi.nlm.nih.gov]
Anteroposterior plain radiography of the chest (Panel B) showed a large, gas-filled structure in the left hemithorax (long arrow), near-complete collapse of the left lung (short arrow), and a marked rightward shift of the mediastinum (arrowhead). [nejm.org]
- Inflammation
Postoperatively, a delayed right diaphragmatic rupture occurred due to progressive inflammation and muscle devitalisation. The diagnosis was challenging because the right rupture became clinically evident later after extubation. [ncbi.nlm.nih.gov]
Those causing symptoms do so because of inflammation of the esophageal lining resulting from gastroesophageal reflux. Typically, the symptoms occur after a full meal and include heartburn and indigestion. [medical-dictionary.thefreedictionary.com]
The most likely explanation is that the diaphragmatic defect occurring with injury manifests only when herniation occurs. 9 Delayed rupture may occur several days after the initial injury as a process of inflammation and necrosis of a devitalized diaphragmatic [rc.rcjournal.com]
When no movement is seen with various maneuvers, fixation of the diaphragm is seen in association with adjacent inflammation (such as pneumonia or subphrenic abscess). [emedicine.medscape.com]
Two of the repairs were performed in contaminated surgical fields, one due to inflammation of the herniated gallbladder and one due to pleural empyema. No septic complications requiring prolonged hospital stay or reintervention were reported. [frontiersin.org]
- Hypoxemia
If ventilation of the lung on the side of the tear is severely inhibited, hypoxemia (low blood oxygen) results.Usually the rupture is on the same side as an impact. [en.wikipedia.org]
However as described before in the literature[ 51 ] and also in the enclosed case report, the laparoscopic repair can be carried out without intraoperative hypoxemia, tension pneumothorax or increased peak airway pressures. [doi.org]
Respiratoric
- Pneumonia
Postoperative pneumonia and pelvic abscess were both treated successfully and he left the hospital in good condition. [ncbi.nlm.nih.gov]
A chest CT on the seventh day of admission showed progressive bilateral pneumonia and was also highly suggestive of rupture of the diaphragm ( Fig. 3 ). [jtraumainj.org]
[…] consolidation The left hemidiaphragm is obscured ( red line = normal position) Consolidation of the left lung base ( highlighted area ) extends behind the heart Clinical information Cough, high temperature and raised white cell count Diagnosis Left lower lobe pneumonia [radiologymasterclass.co.uk]
Afterwards, the patient's progress was very torpid and complicated with right basal pneumonia due to methicillin-resistant Staphylococcus aureus. We used tracheostomy and mechanical ventilation disconnections, which were poorly tolerated. [elsevier.es]
Gastrointestinal
- Abdominal Pain
We present herein a patient who suffered from abdominal pain and dyspnea years after a motor vehicle accident. A chest computed tomography (CT) demonstrated diaphragmatic rupture with intrapericardial herniation of intraabdominal organs. [ncbi.nlm.nih.gov]
- Epigastric Pain
He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. [ncbi.nlm.nih.gov]
pain, thoracic pain rarely gastric herniation or volvulus (vomiting, sepsis if strangulation has occurred) shoulder pain Examination frequently no signs tachypnoea decreased SpO2 tachycardia, hypotension (strangulation) fever decreased chest expansion [lifeinthefastlane.com]
He also had no imaging studies done after the initial incident or during the period he complained of persisting epigastric pain. [afrjtrauma.com]
Bowel sounds may be heard in the chest, and shoulder or epigastric pain may be present. When the injury is not noticed right away, the main symptoms are those that indicate bowel obstruction. [en.wikipedia.org]
Cardiovascular
- Chest Pain
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]
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]
X-Ray
- Atelectasis
Chest radiographic examination after the operation revealed a more normal position of the right diaphragmatic border and resolution of the right lung atelectasis. [ncbi.nlm.nih.gov]
Other non-specific findings on chest x-ray include elevation and/or indistinct margins of the diaphragm, pleural effusion, atelectasis and contralateral mediastinal shift [13]. [ispub.com]
CHEST RADIOGRAPHY Visualization of the stomach or otherabdominal organs in the chest Elevation of the diaphragm Lack of clarity of the hemidiaphragm Abnormal positioning of a nasogastric tube Basilar atelectasis Hemothorax from bleeding in the abdomen [slideshare.net]
- Parenchymatous opacification of almost the entire left lung (except for the anterior segments of the culmen) corresponding to passive parenchymatous atelectasis on the diaphragmatic rupture and probable contusions. - Ventilatory disturbances of the [imaios.com]
In such cases, imaging findings include: elevation of the hemidiaphragm, abrupt discontinuity, nonvisualization of the diaphragm (absent diaphragmatic sign), pleural effusion, atelectasis, and, at times, shift of the mediastinum away from the injured [appliedradiology.com]
- 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]
Sinus cut-off sign" occurs in the presence of blunt diaphragmatic hernia with pleural effusion and is a variant of dependent viscera sign. [ijri.org]
- 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]
- 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
Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. [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]
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. METHODS: This study was performed at the Emergency and General Surgery Department of Fondazione I.R.R.C.S. [ncbi.nlm.nih.gov]
ETIOLOGY DI 0.63% National Trauma Data Bank (NTDB) 65 % Penetrating injury 35 % Blunt injury 4. [slideshare.net]
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]
Epidemiology
We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. [pesquisa.bvsalud.org]
Daoud pp. 179–182 https://doi.org/10.5144/0256-4947.2008.179 Correction(s) for this article retraction notice Volume 32 Issue 6 Annals of Saudi Medicine 26 March 2019 Abstract Full text PDF Abstract Epidemiological aspects of scorpion stings in Al-Jouf [annsaudimed.net]
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]
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]
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 Currently, 80-90% of blunt diaphragmatic ruptures result from motor vehicle crashes (MVCs). Falls and other traumatic events rarely are implicated. [emedicine.com]
Abstract The pathophysiology and complications of blunt diaphragmatic rupture (BDR), an underdiagnosed and potentially life-threatening condition, are reviewed, and 19 CT signs that are suggestive or indicative of BDR are described and classified to facilitate [pubs.rsna.org]
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]
They can interfere with the return of blood to the heart and prevent the heart from filling effectively, reducing cardiac output. [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]
The diaphragm also aids in emesis, urination, and prevention of gastroesophageal reflux. [ijri.org]