Computed Tomography to Diagnose Blunt Diaphragm Injuries: Not Ready for Prime Time

Sprunt, Julie M.; Brown, Carlos; Reifsnyder, Andrew; Shestopalov, Alex V.; Ali, Sádia; Fielder, D.

doi:10.1016/j.jss.2012.10.875

Cited by 4 publications

(6 citation statements)

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“…There are a few studies that have calculated prospective detection rates using methodology similar to our study. One study calculated a sensitivity of 57% in a group of 42 patients with blunt TDR [24] while a second calculated a sensitivity of 77% for blunt trauma and 47% for penetrating trauma in a group of 84 patients [25].…”

Section: Discussionmentioning

confidence: 99%

Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

et al. 2015

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“…A large collective analysis by Fakhry et al [ 27 ] observed normal CT scan results in 13% of patients with small bowel perforation. In blunt diaphragmatic injuries, overall sensitivity has been reported to be as low as 57% [ 28 ], with right-sided injuries being more difficult to identify [ 29 ].…”

Section: Work-up Of Patients Sustaining Abdominal Traumamentioning

confidence: 99%

“…CT scans have only limited sensitivity for diaphragmatic injury [ 28 , 29 ]; thus, laparoscopy can be used to assess for and treat diaphragmatic injuries, if no other indications require laparotomy. In their 10-year experience with laparoscopy both for suspected blunt and penetrating injuries, Johnson and colleagues [ 41 ] avoided laparotomy in 89.3% applying minimally invasive diagnosis and repair.…”

Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

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The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.

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“…Although CXR or CT scan may provide an immediate diagnosis if there is clear herniation present, there are several scenarios where they can be misleading or unreliable [28]. The first is when the stomach is herniated but is full of either liquid or solid contents, and the imaging findings can easily be mistaken for a hemothorax [28].…”

Section: Diagnosis/work-upmentioning

confidence: 99%

“…The first is when the stomach is herniated but is full of either liquid or solid contents, and the imaging findings can easily be mistaken for a hemothorax [28]. There are anecdotal reports of chest tubes being mistakenly placed into the herniated stomach or bowel, although this can be avoided by careful technique in placing the chest tube.…”

Section: Diagnosis/work-upmentioning

confidence: 99%

Penetrating Traumatic Diaphragm Injuries

DeBarros

Martin

2015

Curr Trauma Rep

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Traumatic diaphragm injuries (TDI) are uncommon but can result in major morbidity or mortality if missed. Penetrating thoracoabdominal injuries carry a high risk of TDI, but can also pose a diagnostic dilemma due to their small size and the frequent lack of an associated hernia. Despite advances in imaging, diagnosis without presence of a hernia remains difficult and a high index of suspicion must be maintained. Chest x-ray remains an important tool in early diagnosis, but primarily relies on the presence of a hernia or a discontinuity of the diaphragm, which is not typically seen with penetrating injuries. Computed tomography has a higher sensitivity and specificity and improves preoperative diagnosis, but most TDI are still diagnosed intra-operatively. Minimally invasive modalities allow for both diagnosis and repair of suspected injuries in hemodynamically stable patients while avoiding the morbidity of an open approach. All penetrating diaphragmatic injuries require repair in order to avoid the major morbidity and mortality of a chronic diaphragmatic hernia. The principles of diaphragmatic injury repair are complete reduction of all abdominal contents, lavage and evacuation of any associated hemothorax or gastrointestinal spillage, and watertight, tension-free closure. Most injuries can be closed primarily, but some may require use of prosthetic material or other advanced reconstructive techniques for larger defects. Mortality remains primarily dependent on the mechanism of injury and the presence and severity of associated injuries, with overall Injury Severity Score serving as an independent predictor of early mortality.

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Computed Tomography to Diagnose Blunt Diaphragm Injuries: Not Ready for Prime Time

Cited by 4 publications

References 0 publications

Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

Penetrating Traumatic Diaphragm Injuries

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