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• W2062142411 abstract "Seven proven cases of traumatic rupture of the diaphragm (TRD) following blunt trauma and an extensive 32-article review of 1345 cases of penetrating and blunt trauma are presented. The distribution of TRD was relatively consistent through the decades, with 458 cases of penetrating trauma (34%) and 887 cases of blunt trauma (66%); less than 1% of the cases were iatrogenic. There were 853 left-sided cases (67.2%), 359 right-sided cases (28.3%), and 48 bilateral and 10 central tendon cases (4.5%). In penetrating TRDs, 188 were left-sided (50%), 158 right-sided (42%), and 30 bilateral (8%). In the blunt TRDs, 606 were left-sided (73.1%), 195 right-sided (23.5%), and 18 bilateral and 10 central tendon (3.4%). Over 94% of 926 cases had another organ injured along with the diaphragm. There was an overall mortality of 21.6%; however, no fatalities were directly related to the TRD. Eighty-seven percent of TRDs were diagnosed within 24 hours, 81% within 12 hours, and 72% in less than 6 hours. The location of the laceration along the surface of the diaphragm was imperfectly described in the literature, offering no statistical information. The role of radiographic studies [plain films, barium studies, ultrasound, nuclear medicine, computed tomography (CT), and magnetic resonance imaging (MRI)] vs. surgical outcome in making the diagnosis of TRD is examined. Emphasis was placed on analyzing TRD in blunt trauma since it poses a more challenging clinical and radiographic dilemma in making a preoperative diagnosis. Plain radiographs were suggestive in 77% and diagnostic in 50% of TRD cases, while 47% were diagnosed at surgery and 3% by other radiologic studies. Barium studies are especially useful following a misdiagnosed TRD where the patient presents with a clinical history suspicious for strangulated abdominal viscera that occurred after herniation into the thorax. Radionuclide scanning may demonstrate liver within the thorax that herniated following a right-sided TRD. The role of CT is uncertain since we found only 32 cases (3.6%) in which CT was utilized, and only six of these (18.2%) were diagnostic for TRD. Early studies using MRI show high accuracy in dignosing TRD; it is especially valuable in uncertain cases. At present, nasogastric tube placement and serial chest radiographs are the recommended initial management for evaluating patients with potential TRD." @default.
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• W2062142411 title "Traumatic injury of the diaphragm: Report of seven cases and extensive literature review" @default.
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