II. Causes
- Blunt Trauma to anterior Abdomen (MVA, fall from height, Contact Sports)
- Increased abdominal pressure disrupts diaphragm
- High risk of pre-hospital mortality
- Associated injuries
- Large vessel injury (inferior vena cava, hepatic vein, aorta)
- Hemo-Pneumothorax (90% of cases), liver and Spleen injuries (25%)
- Pelvic Fracture (40%), long bone Fracture (75%) and multiple Rib Fractures
- Closed Head Injury (42%)
-
Penetrating Trauma (Gunshot Wound, Stab Wound)
- May occur from either Thoracic Injury or Abdominal Injury
- Typically small (<2 cm) and linear (and often occult)
- Smaller, more occult diaphragm injuries at risk for Incarcerated Hernias
- Surgical complication
III. Symptoms
V. Imaging: Chest XRay
- First-line study
- Findings
- Stomach or bowel appears in the left chest
- Nasogastric Tube curled in the left chest
- Misdiagnoses (Diaphragmatic Rupture look-alikes)
- Elevated left hemidiaphragm
- Left loculated Pneumothorax
- Left subpulmonary Hematoma
VI. Imaging: CT Chest (or CT Chest, Abdomen and Pelvis)
- Left sided Diaphragmatic Injury is most common
- Right side is shielded by the liver
- Bilateral injury is uncommon
- Efficacy (insufficient to completely exclude diaphragmatic perforation)
VII. Management
- Emergent Trauma surgical Consultation and evaluation (Laparoscopy, thoracoscopy)
- Negative imaging (including CT) does not exclude Diaphragmatic Injury
- Laparoscopy and thoracoscopy are indicated in high suspicion cases (despite negative imaging)
- Missed Diaphragmatic Injury may result in serious complications
VIII. Complications
IX. Prognosis
- Overall mortality
- Penetrating Diaphragmatic Injury: 4.3%
- Blunt Diaphragmatic Injury: 37%
X. References
- Cowling and Mullins (2017) Crit Dec Emerg Med 31(10): 3-10
- Dwivedi (2010) J Emerg Trauma Shock 3(2): 173–6 +PMID:20606795 [PubMed]
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 83336007 |
| Italian | Rottura del diaframma |
| Japanese | 横隔膜破裂, ｵｳｶｸﾏｸﾊﾚﾂ |
| English | diaphragmatic rupture (diagnosis), diaphragmatic rupture, diaphragm rupture, rupture of diaphragm, Diaphragmatic rupture, Rupture of diaphragm, Rupture of the diaphragm, Rupture of diaphragm (disorder), diaphragm; rupture, rupture; diaphragm |
| Czech | Ruptura bránice |
| Hungarian | Rekesz ruptura |
| Dutch | diafragma; ruptuur, ruptuur; diafragma, diafragmatische ruptuur |
| Spanish | ruptura del diafragma (trastorno), ruptura del diafragma, ruptura diafragmática, Rotura diafragmática |
| Portuguese | Ruptura diafragmática |
| French | Rupture diaphragmatique |
| German | Diaphragmaruptur |
