Skip to main content
SpringerLink
Log in
Book cover

Diagnostic Imaging in Polytrauma Patients pp 283–299Cite as

Traumatic Diaphragmatic Injuries

  • Chapter
  • First Online:

  • 1398 Accesses

Abstract

A traumatic diaphragmatic injury (TDI) is a severe lesion that may be caused both by blunt and penetrating trauma, with ratio being different from country to country and derived from social and economic factors. Despite chest X-ray may directly or indirectly suggest the possibility of TDI, whole-body computed tomography represents the examination of choice to demonstrate such a lesion. TDI detection is fundamental in order to avoid delayed critical complications that may be fatal, like visceral intrathoracic herniation with risk of acute respiratory failure and organ strangulation. This is the reason why early diagnosis and prompt surgical repair are mandatory. Nevertheless, TDI often remains undiagnosed depending on the presence of subtle clinical/radiological signs and very frequent concomitant multiorgan life-threatening lesions that overshadow the diaphragm involvement. Therefore, the emergency radiologist should be confident about specific and nonspecific signs of TDI and get familiar with the mechanism of injury, in order to maintain a high degree of suspicion and inform both the emergency clinician and surgeon in time.

This is a preview of subscription content, log in via an institution.

References

  1. Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics. 2012;32:477–98.

    Article  PubMed  Google Scholar 

  2. Nchimi A, Szapiro D, et al. Injuries of the diaphragm. In: Dondelinger RF, editor. Imaging and intervention in abdominal trauma. Berlin: Springer; 2004. p. 205–36.

    Google Scholar 

  3. Panda A, Kumar A, et al. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol. 2014;20:121–8.

    PubMed  PubMed Central  Google Scholar 

  4. Iochum S, Ludig T, et al. Imaging of diaphragmatic injury: a diagnostic challenge? Radiographics. 2002;22:S103–18.

    Article  PubMed  Google Scholar 

  5. Nchimi A, Szapiro D, et al. Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol. 2005;184(1):24–30.

    Article  PubMed  Google Scholar 

  6. Dreizin D, Bergquist PJ, et al. Evolving concepts in MDCT diagnosis of penetrating diaphragmatic injury. Emerg Radiol. 2015;22:149–56.

    Article  PubMed  Google Scholar 

  7. Rees O, Mirvis SE, et al. Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases. Clin Radiol. 2005;60(12):1280–9.

    Article  CAS  PubMed  Google Scholar 

  8. Mirvis SE, Shanmuganathan K. Imaging hemidiaphragmatic injury. Eur Radiol. 2007;17:1411–21.

    Article  PubMed  Google Scholar 

  9. Como JJ, Bokhari F, et al. Practice management guidelines for selective non operative management of penetrating abdominal trauma. J Trauma. 2010;68:721–33.

    Article  PubMed  Google Scholar 

  10. Kaur R, Prabhakar A, et al. Blunt traumatic diaphragmatic hernia: pictorial review of CT signs. Indian J Radiol Imaging. 2015;25:226–32.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Shackleton KL, Stewart ET, et al. Traumatic diaphragmatic injuries: spectrum of radiographic findings. Radiographics. 1998;18:49–59.

    Article  CAS  PubMed  Google Scholar 

  12. Nason LK, Walker CM, et al. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32:E51–70.

    Article  PubMed  Google Scholar 

  13. Chavhan GB, Babyn PS, et al. Multimodalityimaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics. 2010;30:1797–817.

    Article  PubMed  Google Scholar 

  14. Scaglione M, Grassi R, et al. Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report. Acta Radiol. 2000;41:165–6.

    Article  CAS  PubMed  Google Scholar 

  15. Restrepo CS, Eraso A, et al. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008;28(5):1289–305.

    Article  PubMed  Google Scholar 

  16. Schumpelick V, Steinau G, et al. Surgical embryology and anatomy of the diaphragm with surgical applications. Surg Clin North Am. 2000;80(1):213–39, xi.

    Article  CAS  PubMed  Google Scholar 

  17. Sangster G, Ventura Pietro V, et al. Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients. Emerg Radiol. 2007;13:225–30.

    Article  CAS  PubMed  Google Scholar 

  18. Shanmuganathan K, Killeen K, et al. Imaging of diaphragmatic injuries. J Thorac Imaging. 2000;15(2):104–11.

    Article  CAS  PubMed  Google Scholar 

  19. Volterrani L, Mazzei MA, et al. Parete toracica e diaframma. In: Miele V, Scaglione M, et al., editors. Diagnostica per immagini nel trauma maggiore. Milan, Italy: Elsevier Masson; 2010. p. 121–8.

    Google Scholar 

  20. Bocchini G, Guida F, et al. Diaphragmatic injuries after blunt trauma: are they still a challenge? Emerg Radiol. 2012;19:225–35.

    Article  PubMed  Google Scholar 

  21. Bodanapally UK, Shanmuganathan K, et al. MDCT diagnosis of penetrating diaphragm injury. Eur Radiol. 2009;19:1875–81.

    Article  PubMed  Google Scholar 

  22. Sliker CW. Imaging of diaphragm injuries. Radiol Clin N Am. 2006;44:199–211, vii.

    Article  PubMed  Google Scholar 

  23. Chen HW, Wong YC, et al. Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: experience with 43 patients. Clin Radiol. 2010;65(3):206–12.

    Article  PubMed  Google Scholar 

  24. Reiff DA, McGwin G Jr, et al. Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture. J Trauma. 2002;53(6):1139–45.

    Article  PubMed  Google Scholar 

  25. Tresallet C, Menegaux F, et al. Usefulness of CT reconstructed pictures for diaphragmatic rupture after blunt trauma. J Am Coll Surg. 2004;198:666–7.

    Article  PubMed  Google Scholar 

  26. Gelman R, Mirvis SE, et al. Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR Am J Roentgenol. 1991;156:51–7.

    Article  CAS  PubMed  Google Scholar 

  27. Demos TC, Solomon C, et al. Computed tomography in traumatic defects of the diaphragm. Clin Imaging. 1989;13:62–7.

    Article  CAS  PubMed  Google Scholar 

  28. Shanmuganathan K, Mirvis SE. Imaging diagnosis of nonaortic thoracic injury. Radiol Clin N Am. 1999;37:533–51.

    Article  CAS  PubMed  Google Scholar 

  29. Perlman SJ, Rogers LF, et al. Abnormal course of nasogastric tube in traumatic rupture of left hemidiaphragm. AJR Am J Roentgenol. 1984;142(1):85–8.

    Article  CAS  PubMed  Google Scholar 

  30. Gavelli G, Canini R, et al. Traumatic injuries: imaging of thoracic injuries. Eur Radiol. 2002;12(6):1273–94.

    Article  CAS  PubMed  Google Scholar 

  31. Pikoulis E, Delis S, et al. Reliability of initial chest radiographs in the diagnosis of blunt diaphragmatic rupture. Ann Chir Gynaecol. 2000;89(1):10–3.

    CAS  PubMed  Google Scholar 

  32. Scaglione M, Pinto F, et al. CT assessment of blunt diaphragmatic injury. A retrospective study on 35 cases. Radiol Med. 2000;99:46–50.

    CAS  PubMed  Google Scholar 

  33. Larici AR, Gotway MB, et al. Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR. 2002;179:451–7.

    Article  PubMed  Google Scholar 

  34. Hammer MM, Flagg E, et al. Computed tomography of blunt and penetrating diaphragmatic injury: sensitivity and inter-observer agreement of CT signs. Emerg Radiol. 2014;21:143–9.

    Article  PubMed  Google Scholar 

  35. Desser TS, Edwards B, et al. The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol. 2010;17:37–44.

    Article  PubMed  Google Scholar 

  36. Tonerini M. Urgenze dell’esofago e del diaframma. Radiol Med. 2010;115(Suppl):75–80.

    Google Scholar 

  37. Bergin D, Ennis R, et al. The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR. 2001;177:1137–40.

    Article  CAS  PubMed  Google Scholar 

  38. Panicek DM, Benson CB, et al. The diaphragm: anatomic, pathologic, and radiologic considerations. Radiographics. 1988;8(3):385–425.

    Article  CAS  PubMed  Google Scholar 

  39. Caskey CI, Zerhouni EA, et al. Aging of the diaphragm: a CT study. Radiology. 1989;171(2):385–9.

    Article  CAS  PubMed  Google Scholar 

  40. Barbiera F, Nicastro N, et al. The role of MRI in traumatic rupture of the diaphragm. Our experience in three cases and review of the literature. Radiol Med (Torino). 2003;105:188–94.

    Google Scholar 

  41. Eren S, Kantarci M, et al. Imaging of diaphragmatic rupture after trauma. Clin Radiol. 2006;61:467–77.

    Article  CAS  PubMed  Google Scholar 

  42. Lu J, et al. Delayed traumatic diaphragmatic hernia. A case-series report and literature review. Medicine. 2016;95(32):e4362.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Shah R, et al. Traumatic rupture of diaphragm. Ann Thorac Surg. 1995;60(5):1444–9.

    Article  CAS  PubMed  Google Scholar 

  44. Crandall M, et al. Post traumatic hernias: historical overview and review of the literature. Am Surg. 2007;73(9):845–50.

    PubMed  Google Scholar 

  45. Hanna WC, et al. Acute traumatic diaphragmatic injury. Thorac Surg Clin. 2009;19(4):485–9.

    Article  PubMed  Google Scholar 

  46. Liao CH, Chu CH, et al. The feasibility and efficacy of laparoscopic repair for chronic traumatic diaphragmatic herniation: introduction of a novel technique with literature review. Hernia. 2015;20(2):303–9.

    Article  PubMed  Google Scholar 

  47. Thiam O, Konate I, et al. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects. SpringerPlus. 2016;5:1614.

    Article  PubMed Central  PubMed  Google Scholar 

  48. De Lesquen H, Avaro JP, et al. Surgical management for the first 48 h following blunt chest trauma state of the art (excluding vascular injuries). Interact Cardiovasc Thorac Surg. 2014;20(3):399–408.

    Article  PubMed  Google Scholar 

  49. Yildar M, Yaman I, et al. Laparoscopic repair in simultaneous occurrence of recurrent chronic traumatic diaphragmatic hernia and transdiaphragmatic intercostal hernia. Arq Bras Cir Dig. 2015;28(1):90–2.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Safdar G, Slater R et al. Laparoscopically assisted repair of an acute traumatic diaphragmatic hernia. BMJ Case Rep. 2013. pii: bcr2013009415.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Radiology, Cisanello University Hospital, Pisa, Italy

    Michele Tonerini

  2. Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy

    Silvia Lorenzi, Francesca Pancrazi, Barbara Mugellini, Alessandra Scionti & Veronica Iodice

Authors
  1. Michele Tonerini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Silvia Lorenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesca Pancrazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Mugellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandra Scionti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Veronica Iodice
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Tonerini .

Editor information

Editors and Affiliations

  1. Department of Radiology, Careggi University Hospital, Florence, Italy

    Vittorio Miele

  2. Dept of Emergency Radiology, S. Camillo Hospital, Rome, Italy

    Margherita Trinci

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Tonerini, M., Lorenzi, S., Pancrazi, F., Mugellini, B., Scionti, A., Iodice, V. (2018). Traumatic Diaphragmatic Injuries. In: Miele, V., Trinci, M. (eds) Diagnostic Imaging in Polytrauma Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-62054-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62054-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62053-4

  • Online ISBN: 978-3-319-62054-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation