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Diaphragmatic Rupture

Diaphragm Rupture


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]
  • Abstract 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]
  • Surgical correction was indicated secondary to the symptomatic nature of the presentation. CONCLUSION: 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 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]
Hypoventilation
  • 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]
  • We present a case of a 41-year-old woman who presented with abdominal pain, vomiting and hypoventilation four days after a full-term home delivery.[ncbi.nlm.nih.gov]
Hoarseness
  • A 73-year-old man was admitted with cough, hoarseness and dysphagia caused by a huge laryngeal cancer obstructing the airways.[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]
  • Abstract 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 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]
  • We describe a case of an 18-year old patient admitted 2 hours after onset, presenting severe epigastric and left sided chest pain without any trauma history.[ncbi.nlm.nih.gov]

Workup

  • Diagnostic workup raised the suspicion of a right diaphragmatic rupture that was eventually confirmed by surgery (right-sided thoracotomy).[ncbi.nlm.nih.gov]
  • 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]
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]
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]
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]
Suppression
  • The treatment consisted of a classical management of diaphragmatic rupture, with excision of the endometriotic nodule followed by medical ovarian suppression for six months.[ncbi.nlm.nih.gov]

Treatment

  • BACKGROUND: 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]
  • […] the time, the injury is repaired during laparotomy. [10] 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]

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]
  • The etiological factors, management and outcomes were discussed. RESULTS: 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]
  • Injuries/diagnosis* Abdominal Injuries/surgery Accidents, Traffic Aged Diaphragm/diagnostic imaging Diaphragm/injuries* Diaphragm/surgery Follow-Up Studies Fractures, Bone Hernia, Diaphragmatic, Traumatic/diagnosis* Hernia, Diaphragmatic, Traumatic/etiology[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]
  • 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

  • […] 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. [10] Epidemiology[en.wikipedia.org]
  • Daoud pp. 179–182 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 Province, Saudi Arabia Bashir M.[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]
Sex distribution
Age distribution

Pathophysiology

  • Abstract 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]
  • 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]
  • The anatomic, embryologic, and pathophysiologic information necessary to recognize each sign and differentiate it from others is provided.[doi.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]
  • 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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