Traumatic diaphragmatic injury (DI) is a unique clinical entity that is usually occult and can easily be missed. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of DI challenging to the trauma surgeons. An emergency laparotomy and thorough exploration followed by the repair of the defect is the gold standard for the management of these cases. We report a case of blunt DI in an elderly gentleman and present a comprehensive overview for the management of traumatic injuries of the diaphragm.

Objective: The aim of this study was to evaluate the efficacy of ultrasonography in the diagnosis of swellings in the head and neck regions. Methods: For this study, 70 cases with clinically obvious swellings in head and neck regions were selected randomly. The ultrasonographic features considered were shape, boundary, echo intensity, ultrasound architecture of lesion, posterior echoes and ultrasound characteristic of tissues. Intergroup comparisons were made between four different types of swellings: inflammatory; cystic; benign; and malignant. Results: A comparison was made between benign and malignant neoplasms, and the criteria of boundary, echo intensity and ultrasound architecture of lesions are statistically significant as the P-value is ,0.05. The comparison of inflammatory swellings and malignant neoplasms shows that criteria of boundary and ultrasound architecture of lesions are statistically significant. The comparison of cystic swellings and benign neoplasms concluded that only the criterion of ultrasound characteristics of tissues is statistically significant. The comparison of inflammatory swellings and benign neoplasms shows that the criteria of boundary and echo intensity are statistically significant. The comparison of inflammatory swellings and cystic swellings concluded that the criteria of boundary, shape, echo intensity, posterior echoes and ultrasound characteristics of tissues are statistically significant. The comparison of cystic swellings and malignant neoplasms concluded that the criteria of ultrasonography, boundary, shape, echo intensity, ultrasound architecture of lesion, posterior echoes and ultrasound characteristics of tissues are statistically significant as the P-value is ,0.05. Conclusion: It can be concluded that clinical diagnosis had a sensitivity and accuracy of 85.7% and ultrasonographic diagnosis had a sensitivity and accuracy of 98.5%.

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