Unravelling the Mysteries of Traumatic Diaphragmatic Injury: An Up-to-Date Review

Abstract

<jats:p> Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries. </jats:p>

A 15-Year-Old Female Presenting With Traumatic Diaphragmatic Hernia One Year After a Car Accident

“…While most TDHs present acutely after the inciting trauma, TDH can occasionally present much later, as was the case with our patient. These so-called delayed or chronic TDHs are not common and are usually caused by diaphragmatic tears which are smaller than the tears typically seen in acute TDHs [ 3 , 8 ].…”

Blunt Traumatic Diaphragmatic Hernia in Children: A Systematic Review

“…A review of the literature regarding radiologic detection of TDH by plain films reports sensitivities ranging from 27% to 62% for left TDH and 17% for right TDH. 5 Although CT imaging offers more detailed data regarding intrathoracic and intraabdominal injuries, the sensitivity is still too low to reliably rule out diaphragmatic injury. One study of 157 adult patients with TDH undergoing CT imaging found a sensitivity of only 47.1%.…”

Bilateral delayed traumatic diaphragmatic injury

“…A very common problem with traumatic diaphragmatic injuries is primary diagnosis. There exist many radiologic indirect signs [ 1 , 3 , 9 ], but even with the technical progress of multidetector CT, a traumatic diaphragmatic lesion is missed in up to over 60% [ 1 , 9 ] in the initial imaging. The major amount of patients is diagnosed during emergency surgery due to other threatening intraabdominal or thoracical injuries, especially in penetrating trauma because of the defect form caused by white weapons [ 4 , 7 , 10 ].…”

“…The major amount of patients is diagnosed during emergency surgery due to other threatening intraabdominal or thoracical injuries, especially in penetrating trauma because of the defect form caused by white weapons [ 4 , 7 , 10 ]. Up to decades later [ 7 ], previously undetected traumatic diaphragmatic hernias are usually diagnosed due to secondary complications like obstruction and/or organ strangulation amongst others [ 9 ]. Therefore, preoperative CT scans, mostly thoracoabdominal, are widely available.…”