Management Algorithm for Acute and Chronic Diaphragmatic Injuries

Abstract

Diaphragmatic injury remains an elusive diagnosis for many clinicians as these injuries are often asymptomatic or masked by more severe concomitant injuries at time of presentation. A management algorithm focusing on expedient diagnosis and treatment of these injuries is essential to minimize the long-term morbidity and potential mortality associated with untreated diaphragmatic injuries. The most crucial diagnostic tool in diaphragmatic injury diagnosis is a high degree of suspicion. This can be supplemented with adjunctive imaging though management is primarily operative. Clinical presentation of diaphragmatic injury can be stratified based upon chronicity of injury. In the acute setting, most diaphragmatic injuries are often found during intervention for concomitant injury. These injuries are primarily via an abdominal approach. Chronic injuries typically present with symptoms of obstruction or respiratory compromise and are conversely repaired through a thoracic approach. Variations on repair technique depend on additional findings at time of intervention.