Beyond E‐FAST scan in trauma: Diagnosing of traumatic diaphragmatic rupture with bedside ultrasound

Tjhia, Jollis; Noor, Julina Md

doi:10.1177/1024907917745234

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…With the advancement of knowledge in ultrasound, FAST protocol can be taken to another level. The placement of the probe at the same place as in FAST scan, other pathologies can also be identified, such as atelectasis and diaphragmatic hernia [6, 7]. In our case, partial visualization of the cardiac image with the presence of A-lines on subxiphoid view, coupled with A-lines on all other cardiac views, is highly suggestive of pneumopericardium.…”

Section: Discussionmentioning

confidence: 61%

Cardiac A-lines in fast scan as a sign of pneumopericardium

Noor

Eddie

2019

Ultrasound J

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Background Traumatic pneumopericardium is rare and usually results from blunt injury. Diagnosis through clinical and chest X-ray is often difficult. Ultrasound findings of A-line artifacts in the cardiac window may suggest pneumopericardium. Case presentation A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis. Conclusions Although FAST scan was originally used to look for presence of free fluid, with the knowledge of lung ultrasound for pneumothorax, our findings suggest that FAST scan can also be used to detect pneumopericardium.

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Section: Discussionmentioning

confidence: 61%

Cardiac A-lines in fast scan as a sign of pneumopericardium

Noor

Eddie

2019

Ultrasound J

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“…Chest tube insertion was performed by the surgeon before CT A B traumatic diaphragm rupture. (12) In Table 1 we provide some cases that have been reported in the last 5 years in contrast to the present case.…”

Section: Discussionmentioning

confidence: 92%

Delayed asymptomatic blunt traumatic diaphragmatic hernia: an unusual case report

Revata¹,

Rahmansyah

2022

Univ Med

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IntroductionTraumatic diaphragmatic hernia (TDH) is uncommon, being encountered in around 0.8%-8% of patients with blunt abdominal trauma. Severe comorbidities such as fractures and thoraco-abdominal or head injuries that accompany TDH, are responsible for poor prognosis and often mask diaphragmatic injury itself. Objective of this case report was to highlight rare blunt TDH case to avoid missed diagnosis leading to complications. Case descriptionSixty seven-year old man presenting with right chest pain without difficulty of breathing after falling from stairs 1 hour before hospital admission. On clinical examination, vitals were stable, but with decreased breath sounds on right lower side of chest. Patient had history of trauma from being crushed by elevator 40 years ago without any proven diaphragmatic injury. Initial erect chest X-ray findings were inhomogeneous opacity shadow on lower right hemithorax suspected to be diaphragmatic hernia and 7th right rib fracture with pleural effusion. Thorax CT scan showed herniated right lobe of liver, gall bladder, and mesenteric fat on right hemithorax causing displacement of mediastinal structures. Patient was diagnosed with delayed TDH and hemothorax caused by newly fractured rib. Patient was referred to a better-equipped facility due to the limited surgical facilities in referring hospital. ConclusionDelayed TDHs are not common, but can lead to serious consequences. Blunt TDH occurs more often on left than on right side, in ratio of approximately 3:1. Traumatic diaphragmatic hernia is sometimes diagnosed many years after traumatic event due to latent phase of disease possibly ranging from days to years.

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“…Sonographic features that may suggest TDI are poor diaphragmatic excursion, elevated/floating diaphragm, absent liver sliding sign, rips absent organ sign (nonvisualized spleen, heart), thoracic spleen sign, thoracic peristalsis sign and discontinuity/absent hyperechoic curvilinear line above liver, spleen. [ 9 10 ] However, TDI should be confirmed finally using CT/MRI imaging.…”

Section: Discussionmentioning

confidence: 99%

Need for a change – Extended-FAST to extended diaphragmatic-FAST

Mahalingam¹,

Rajendran²,

Balassoundaram³

et al. 2021

J Med Ultrasound

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Post-traumatic hypoxia can be due to different causes, namely airway problems, pneumothorax, hemothorax, lung contusion, flail chest, traumatic diaphragmatic injuries (TDI), aspiration due to low sensorium, a respiratory paradox in cervical spine injury, severe hypotension, etc., It is a great challenge to identify the cause of hypoxia in a trauma setting because the contributing factors can be multiple or can be a remote cause, which is often missed out. Here, we describe a 50-year-old female who presented to our emergency department with Post-traumatic hypoxia whose sensorium, blood pressure, chest X-ray, E-FAST computed tomography of brain, and other baseline investigation were completely normal, diagnosed later as TDI with the help of diaphragmatic ultrasound and computed tomography of thorax.

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Beyond E‐FAST scan in trauma: Diagnosing of traumatic diaphragmatic rupture with bedside ultrasound

Cited by 6 publications

References 9 publications

Cardiac A-lines in fast scan as a sign of pneumopericardium

Cardiac A-lines in fast scan as a sign of pneumopericardium

Delayed asymptomatic blunt traumatic diaphragmatic hernia: an unusual case report

Need for a change – Extended-FAST to extended diaphragmatic-FAST

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