Imaging evaluation of diaphragmatic injuries: Improving interpretation accuracy

Paes, Fabio M.; Durso, Anthony M.; Danton, Gary H.; Castellon, Ivan; Múnera, Felipe

doi:10.1016/j.ejrad.2020.109134

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Diagnostic laparoscopy is also vital in such patients, as diagnosing DR solely based on CECT findings can be unreliable. 9 By contrast, abdominopelvic CECT has a low sensitivity for diagnosing urinary bladder injury. Impaired renal function, injury to the upper urinary tract, suboptimal excretion of intravenous contrast, and nondistended urinary bladder are plausible reasons for the underreporting of urinary bladder injuries on the CECT abdomen and pelvis.…”

Section: Discussionmentioning

confidence: 99%

Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen

Dugar,

Mohanty,

Muhammed

2024

TPJ

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The authors examined a 25-year-old man with a combined rupture of the diaphragm and urinary bladder following blunt trauma to the abdomen. The presence of hematuria, suprapubic tenderness, and elevated serum urea and creatinine levels in this patient raised suspicion of urinary bladder rupture. Documentation of bowel gas shadows on the chest x-ray suggested underlying diaphragm injury. A computed tomogram of the thorax and abdomen confirmed the tear in the left hemidiaphragm with intrathoracic herniation of abdominal contents; however, it failed to detect the intraperitoneal urinary bladder rupture. Both the defects were identified and repaired during laparotomy. The sudden increase in intraabdominal pressure in blunt trauma to the abdomen often resulted in full-thickness tears of the diaphragm and the urinary bladder. Although radiological investigations were pivotal for assessing the damage to the internal organs, a methodical and thorough exploratory laparotomy was invaluable for successfully managing patients with blunt abdominal trauma.

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Section: Discussionmentioning

confidence: 99%

Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen

Dugar,

Mohanty,

Muhammed

2024

TPJ

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“…Chest and abdominal CT scan can evaluate the intrathoracic complications of the herniated abdominal organs [ 54 ]. The various radiological findings which have been described in the literature include: diaphragmatic discontinuity, segmental non-recognition of the diaphragm, “Dangling diaphragm” sign (visualization of the free edge of the ruptured diaphragm curling toward the center of the abdomen away from the chest wall) [ 55 ], “Dependent viscera” sign [ 56 ] (no space between the liver, bowel or stomach and the chest wall, described as abutted), intrathoracic herniation of abdominal contents, “Collar sign” (constriction of the herniating abdominal organ at the level of the rupture) [ 57 ], contiguous injuries of both sides of the diaphragm, elevated abdominal organs, thickened diaphragm, thoracic fluid, abutting intra-abdominal viscera, hypo-attenuated hemidiaphragm and associated fractured ribs [ 28 , 58 – 60 ]. CT scan findings of ischemia include forward displacement of the gastric bubble, the missing of the gastric folds, the absence of gastric walls contrast enhancement, intestinal wall thickening with target enhancement, spontaneous hyper-density of the intestinal wall, lack of enhancement after injection of iodinated contrast agent, and parietal pneumatosis with portal and mesenteric venous gas [ 53 , 61 ].…”

Section: What Is the Best Way To Diagnose Dh In The Emergency Setting?mentioning

confidence: 99%

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

et al. 2023

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Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.

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“…Another revealing finding suggestive of diaphragmatic injury involves the unusual path of a nasogastric tube above the hemidiaphragm. 28 Numerous CT-based indicators of diaphragmatic rupture have been documented and classified into direct signs, where a visible defect in the diaphragm is observed, and indirect signs, encompassing the consequences of diaphragmatic injury. 29 These signs vary in their reliability for confirming the presence of diaphragmatic injury.…”

Section: Chest Wallmentioning

confidence: 99%

Comparative Review of Computed Tomography Scans and Radiography in Evaluating Blunt Chest Trauma

Ali Alshahrani,

Hamad Alqorea,

Abdullah Alammari

et al. 2023

Int J Life Sci Pharm Res

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Previous comparative studies revealed that a substantial proportion of blunt chest trauma often goes unnoticed when evaluated \with chest X-rays. The computed tomography scan, therefore, could play an important role in the initial assessment of patients following blunt chest trauma. This review aims to highlight the findings of chest computed tomography scans and compare them to chest radiography in patients with thoracic trauma resulting from blunt trauma. A systematic search across diverse online databases was performed in PubMed, MEDLINE, and Embase databases. The study selection process was guided by inclusion criteria that focused on individuals afflicted with chest injuries following accidents, engaged in a direct comparison of the diagnostic efficacy of chest CT scans and conventional chest X-rays, and was available in English. In the medical literature, chest radiography and CT imaging provide essential insights to guide clinical decision-making. The precise ability to distinguish between typical and atypical indications of damage across both superficial and deeper anatomical structures holds considerable importance during the initial assessment of such cases. A systematic approach, exemplified through the proposed "outside-in" sequence, offers a proficient strategy to evaluate all potential injuries comprehensively. This approach streamlines the evaluation process, ultimately empowering the medical team to promptly and effectively identify and manage these injuries.

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Imaging evaluation of diaphragmatic injuries: Improving interpretation accuracy

Cited by 8 publications

References 27 publications

Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen

Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

Comparative Review of Computed Tomography Scans and Radiography in Evaluating Blunt Chest Trauma

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