The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture

Shapiro, Marc J.; Heiberg, Elisabeth; Durham, Rodney M.; Luchtefeld, William B.; Mazuski, John E.

doi:10.1016/s0009-9260(96)80214-5

Cited by 101 publications

(49 citation statements)

References 25 publications

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“…This may account for the great variability (7-66%) of initially missed DI seen in polytrauma patients reported in the literature [3,24,30,31,33,34]. Admission radiographs are diagnostic in 27-62% of patients with left-sided and in 18-33% of cases with right-sided injuries [1,17,26,35,36]. Chest radiographs are suggestive but not diagnostic in another 18% of cases [22,33].…”

Section: Chest Radiographymentioning

confidence: 99%

“…Conventional CT has a variable sensitivity of 14-61% and specificity of 76-99% for diagnosing diaphragm rupture [6,13,32,33,35]. Limitations of conventional CT include difficulty in visualizing the entire dome-shaped diaphragm on axially oriented images, low-resolution sagittal and coronal reformatted images performed with 8-10 mm axial slice thickness, and difficulty differentiating the diaphragm from adjacent pulmonary pathology or normal soft tissue structures.…”

Section: Techniquementioning

confidence: 99%

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Imaging hemidiaphragmatic injury

Shanmuganagthan

2007

Eur Radiol

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Section: Chest Radiographymentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

Imaging hemidiaphragmatic injury

Shanmuganagthan

2007

Eur Radiol

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“…Initial reports found CT to have sensitivity equal to that of chest radiography (i.e., 0-50%) [1,8]. Because of a dramatic reduction in motion and beam-hardening artifacts and significant improvement of spatial resolution, especially along the z-axis, helical CT and multisection CT allow better demonstration of most subtle signs of diaphragmatic herniation.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

2012

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Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients with blunt thoracoabdominal injury (16.23%) were studied. Age range was 8-60 years (mean 34 years). Male-female ratio was 18:1. Various features seen on CT scan were diaphragmatic discontinuity in 13 (68.42%), thickened diaphragm in 10 (52.63%), "collar sign" in 8 (42.10%), visceral herniation in 12 (63.15%), dependent viscera sign in 8 (42.10%), and segmental nonrecognition of the diaphragm in 1 patient (5.88%). Two patients presented with delayed rupture. In the rest mean duration between time of injury and performance of CT scan was 44.35 h (range 3-288 h). Fourteen patients underwent operative management. Sensitivity, specificity, and accuracy of MDCT scan were 100, 93, and 95%, respectively. Three patients (15.78%) expired. MDCT is a highly accurate modality for detecting traumatic diaphragmatic hernia.

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“…12 The preoperative diagnosis of diaphragmatic rupture is a challenge, with rates ranging from 30% to 61%. 10,13 In this case reported, the patient underwent a complex surgical procedure with the potential for serious complications, so the multidisciplinary approach of the anesthetic-surgical team was essential. After liver replacement into the abdominal cavity, there were the hemodynamic changes already reported, but the team was prepared for an eventual loss of dwelling-place by the organ or vessel injury and progress to a liver autograft, which was not necessary.…”

Section: Discussionmentioning

confidence: 96%

Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case

Lugarinho-Monteiro

Pereira

Seco

2018

Brazilian Journal of Anesthesiology (English Edition)

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Background: Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. Case report: We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia after a car accident when she was 8 years old. Clinically, she had severe restrictive respiratory syndrome caused by the hepatothorax. The anesthetic evaluation was normal, except for the chest X-ray showing elevation of the dome of the right hemidiaphragm without tracheal deviation. Diagnosis was confirmed by CT scan. After liver replacement in the abdominal cavity, a transient increase in central venous pressure, stroke volume index and flow time corrected (35%), and a decrease in systemic vascular resistance were observed. After complete hemodynamic and hepatosplenic stabilization, as well as ventilation, the patient was transferred intubated, under controlled ventilation and monitored, to the liver transplant unit. Conclusions: Hepatothorax is a rare condition and its repair may represent an anesthetic challenge. After liver replacement in the abdominal cavity during corrective surgery under general anesthesia complications may occur, particularly associated with pulmonary re-expansion. Effective teamwork and careful planning of surgery, between the surgical and anesthetic teams, are the key to success. Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case 191 PALAVRAS-CHAVEHepatotórax; Anestesia; Lesão diafragmática Hepatotórax crônico devido à ruptura do diafragma direito: um desafio anestésico em um caso raro Resumo Justificativa: A ruptura diafragmática é uma condição incomum e ocorre em 90% no lado esquerdo. No entanto, a incidência de ruptura à direita tem vindo a aumentar junto com o aumento dos acidentes automobilísticos. A herniação do fígado pode tornar-se progressiva, causar atelectasia grave do pulmão direito, resultar num débil estado respiratório e alterações hemodinâmicas. Relato de caso: Mulher de 40 anos, estado físico ASA 3, marcada para reparação de hepatotórax que evoluiu de hérnia diafragmática direita, adquirida aos 8 anos, após um acidente automobilístico. Clinicamente apresentava síndrome respiratória restritiva grave, causada pelo hepatotórax. A avaliação anestésica era normal, com exceção da radiografia do tórax, que evidenciava elevação da hemicúpula diafragmática direita, sem desvio traqueal. Diagnóstico foi confirmado por tomografia computadorizada. Depois da recolocação do fígado na cavidade abdominal foram observados um aumento transitório da pressão venosa central, do Stroke Volume Index e Flow Time Corrected (35%) e uma diminuição da resistência vascular sistêmica. Uma vez alcançada a estabilização hemodinâmica geral e hepatoesp...

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The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture

Cited by 101 publications

References 25 publications

Imaging hemidiaphragmatic injury

Imaging hemidiaphragmatic injury

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case

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