34:
241:. With penetrating trauma, the contents of the abdomen may not herniate into the chest cavity right away, but they may do so later, causing the presentation to be delayed. Since the diaphragm moves up and down during breathing, penetrating trauma to various parts of the torso may injure the diaphragm; penetrating injuries as high as the third rib and as low as the twelfth have been found to injure the diaphragm. Iatrogenic cases have occurred as a complication of medical procedures involving the thorax or abdomen. It has occurred as a complication of
62:
328:
a rupture, a sign known as the collar sign. If the liver herniates through a rupture on the right side, it may produce two signs known as the hump and band signs. The hump sign is a form of the collar sign on the right. The band sign is a bright line that intersects the liver. it is believed to result due to the ruptured diaphragm compressing. Although CT scanning increases chances that diaphragmatic rupture will be diagnosed before surgery, the rate of diagnosis before surgery is still only 31–43.5%. Another diagnostic method is
348:, which is situated in the right upper quadrant of the abdomen, cushions the diaphragm. However, injuries occurring on the left side are also easier to detect in X-ray films. Half of diaphragmatic ruptures that occur on the right side are associated with liver injury. Injuries occurring on the right are associated with a higher rate of death and more numerous and serious accompanying injuries. Bilateral diaphragmatic rupture, which occurs in 1–2% of ruptures, is associated with a much higher death rate (
361:
316:
476:
446:
332:, but this misses diaphragmatic ruptures up to 15% of the time. Often diaphragmatic injury is discovered during a laparotomy that was undertaken because of another abdominal injury. Because laparotomies are more common in those with penetrating trauma than compared to those who experienced a blunt force injury, diaphragmatic rupture is found more often in these people.
151:, and surgical techniques such as an explorative surgery. Diagnosis is often difficult because signs may not show up on X-ray, or signs that do show up appear similar to other conditions. Signs and symptoms include chest and abdominal pain, difficulty breathing, and decreased lung sounds. When a tear is discovered, surgery is needed to repair it.
410:
injuries are associated in as many as 80–100% of cases. In fact, if the diaphragm is injured, it is an indication that more severe injuries to organs may have occurred. Thus, the mortality after a diagnosis of diaphragmatic rupture is 17%, with most deaths due to lung complications. Common associated injuries include
483:
Diaphragmatic rupture is a common and well-known complication of blunt abdominal trauma in cats and dogs. The organs that herniate into the pleural cavity are determined by the location of the rupture. They are most commonly circumferential tears that occur at the attachment of the diaphragm and rib.
462:
made the first description of diaphragmatic rupture in a French artillery captain who had been shot eight months before his death. He died from complications of the rupture. Using autopsies, Paré also described diaphragmatic rupture in people who had suffered blunt and penetrating trauma. Reports of
215:
causes (as a result of medical intervention), for example during surgery to the abdomen or chest. It has also occurred spontaneously at the time of pregnancy or for no discernible reason. Injury to the diaphragm is reported to be present in 8% of cases of blunt chest trauma. In cases of blunt trauma,
327:
has an increased accuracy of diagnosis over X-ray, but no specific findings on a CT scan exist to establish a diagnosis. The free edge of a ruptured diaphragm may curl and become perpendicular to the chest wall, a sign known as a dangling diaphragm. A herniated organ may constrict at the location of
368:
Since the diaphragm is in constant motion with respiration, and because it is under tension, lacerations will not heal on their own. The injury usually becomes larger with time if not repaired. The main goals of surgery are to repair any injuries to the diaphragm and to move any herniated abdominal
754:
A sudden increase in the pressure gradient between the pleural and peritoneal cavities that occurs with high-speed blunt trauma will lead to disruptions of the diaphragm... This same pleuroperitoneal pressure gradient will also promote migration of intraperitoneal structures into the pleural space
257:
Although the mechanism is unknown, it is proposed that a blow to the abdomen may raise the pressure within the abdomen so high that the diaphragm ruptures. Blunt trauma creates a large pressure gradient between the abdominal and thoracic cavities; this gradient, in addition to causing the rupture,
409:
may be associated with a higher risk of diaphragmatic rupture in people involved in vehicle accidents. Over 90% occur due to trauma from vehicle accidents. Due to the great force needed to rupture the diaphragm, it is rare for the diaphragm alone to be injured, especially in blunt trauma; other
307:
for diaphragmatic rupture, but it is rare. The X-ray is better able to detect the injury when taken from the back with the person upright, but this is not usually possible because the person is usually not stable enough; thus it is usually taken from the front with the person lying supine.
262:
interfere with heart function and lung function. High intrathoracic pressure results in an increase in right atrial pressure, disrupting the filling of the heart and venous return of blood. As venous return determines cardiac output, this results in a reduction of cardiac output. If
508:. Dorsal tears are uncommon, and may cause a kidney to herniate into the thorax. Symptoms include difficulty breathing, vomiting, collapse, and an absence of palpable organs in the abdomen. Symptoms can worsen quickly and be lethal, especially in the case of severe bleeding,
220:
and falls are the most common causes. Penetrating trauma has been reported to cause 12.3–20% of cases, but it has also been proposed as a more common cause than blunt trauma; discrepancies could be due to varying regional, social, and economic factors in the areas studied.
154:
Injuries to the diaphragm are usually accompanied by other injuries, and they indicate that more severe injury may have occurred. The outcome often depends more on associated injuries than on the diaphragmatic injury itself. Since the pressure is higher in the
393:) for diaphragmatic rupture after blunt and penetrating trauma is estimated to be 15–40% and 10–30% respectively, but other injuries play a large role in determining outcome. Herniation of abdominal organs is present in 3–4% of people with
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Physical examinations are not accurate, as there is usually no specific physical sign that can be used to diagnose this condition. Thoracoscopic and laparoscopic methods can be accurate.
271:(low blood oxygen) results. Usually, the rupture is on the same side as an impact. A blow to the side is three times more likely to cause diaphragmatic rupture than a blow to the front.
467:, which results from a congenital malformation of the diaphragm. In 1888, Naumann repaired a hernia of the stomach into the left chest that was caused by trauma.
1327:
463:
diaphragmatic herniation due to injury date back at least as far as the 17th century. Petit was the first to establish the difference between acquired and
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after disruption has occurred. Once the viscera have been displaced into the pleural space, both cardiovascular and respiratory functions are compromised.
369:
organs back to their original place. This is done by debriding nonviable tissue and closing the rupture. Most of the time, the injury is repaired during
373:. Early surgery is important, as diaphragmatic atrophy and adhesions occur over time. Sutures are used in the repair. Other injuries, such as
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helps keep the abdominal organs from herniating into the chest cavity, but this also can prevent the injury from being discovered on an X-ray.
1663:
963:
Asensio JA, Petrone P, Demitriades D, commentary by Davis JW (2003). "Injury to the diaphragm". In Moore EE, Feliciano DV, Mattox KL (eds.).
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is more reliable in detecting diaphragmatic tears than laparotomy and is especially useful when chronic diaphragmatic hernia is suspected.
405:
Diaphragmatic injuries are present in 1–7% of people with significant blunt trauma and an average of 3% of abdominal injuries. A high
163:, rupture of the diaphragm is almost always associated with herniation of abdominal organs into the chest cavity, which is called a
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In most cases, isolated diaphragmatic rupture is associated with good outcome if it is surgically repaired. The death rate (
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1993:
140:. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 0.5% of all people with trauma.
512:, or strangulation of herniated intestine. It is also possible that there may only be subtle signs, and the condition
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1998:
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377:, may present a more immediate threat and may need to be treated first if they accompany diaphragmatic rupture.
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McGillicuddy D, Rosen P (August 2007). "Diagnostic dilemmas and current controversies in blunt chest trauma".
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masks the injury on the X-ray film. Half the time, initial X-rays are normal; in most of those that are not,
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can cause diaphragmatic injuries. Clinicians are trained to suspect diaphragmatic rupture particularly if
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pain may be present. When the injury is not noticed right away, the main symptoms are those that indicate
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2013:
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1090:"A Diaphragmatic Hernia and Pericardial Rupture Caused by Blunt Injury of the Chest: A Case Review"
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can also cause abdominal contents to herniate into the thoracic cavity. Abdominal contents in the
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Between 50 and 80% of diaphragmatic ruptures occur on the left side. It is possible that the
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Fleisher GR, Ludwig S, Henretig FM, Ruddy RM, Silverman BK, eds. (2006). "Thoracic trauma".
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in the abdomen may be present. Bowel sounds may be heard in the chest, and shoulder or
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552:"Post traumatic intra thoracic spleen presenting with upper GI bleed! A case report"
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Axial lower chest CT scan showing bowel herniation due to left diaphragmatic rupture
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183:. In people with herniation of abdominal organs, signs of intestinal blockage or
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Scharff JR, Naunheim KS (February 2007). "Traumatic diaphragmatic injuries".
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from the stomach may appear on the film in the chest cavity; this sign is
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is known to be unreliable in diagnosing diaphragmatic rupture; it has low
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1233:"Use of Ultrasound to Diagnose Diaphragmatic Rupture in Dogs and Cats"
1003:. Hagerstown, MD: Lippincott Williams & Wilkins. pp. 1446–7.
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Desir A, Ghaye B (2012-03-01). "CT of Blunt
Diaphragmatic Rupture".
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Mason RJ, Slutsky A, Murray JF, Nadel JA, Gotway MB (2015-03-17).
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Karmy-Jones R, Jurkovich GJ (March 2004). "Blunt chest trauma".
442:. Associated injuries can occur in over three quarters of cases.
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Gao R, Jia D, Zhao H, WeiWei Z, Yangming WF (September 2018).
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Murray & Nadel's
Textbook of Respiratory Medicine E-Book
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of the lung on the side of the tear is severely inhibited,
136:. Most commonly, acquired diaphragmatic tears result from
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917:
Sliker CW (March 2006). "Imaging of diaphragm injuries".
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Weyant MJ, Fullerton DA (2008). "Blunt thoracic trauma".
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Is these cases, the organs that herniate may include the
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months to years after the injury during a medical scan.
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Left posterior diaphragmatic rupture undergoing surgery
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550:Hariharan D, Singhal R, Kinra S, Chilton A (2006).
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1231:Spattini G, Rossi F, Vignoli M, Lamb CR (2003).
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680:. Elsevier Health Sciences. pp. 1622–1623.
167:. This herniation can interfere with breathing.
884:Seminars in Thoracic and Cardiovascular Surgery
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967:. McGraw-Hill Professional. pp. 613–616.
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1664:Focused assessment with sonography for trauma
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352:) than injuries that occur on just one side.
287:for the injury. Often another injury such as
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610:"Diaphragm and transdiaphragmatic injuries"
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1001:Textbook of Pediatric Emergency Medicine
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203:Diaphragmatic rupture may be caused by
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1994:Acute respiratory distress syndrome
1147:"CT of Blunt Diaphragmatic Rupture"
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1145:Desir A, Desir B (5 March 2012).
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1999:Chronic traumatic encephalopathy
1030:Annals of Translational Medicine
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397:who present to a trauma center.
75:Difficulty breathing, chest pain
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465:congenital diaphragmatic hernia
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2050:Post-traumatic stress disorder
852:10.1016/j.thorsurg.2007.03.006
479:Diaphragmatic rupture in a dog
143:Diagnostic techniques include
16:Tear in the thoracic diaphragm
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896:10.1053/j.semtcvs.2008.01.002
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514:is only incidentally detected
310:Positive pressure ventilation
1691:Advanced trauma life support
1659:Diagnostic peritoneal lavage
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742:10.1016/j.cpsurg.2003.12.004
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730:Current Problems in Surgery
614:Journal of Thoracic Disease
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379:Video-assisted thoracoscopy
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285:sensitivity and specificity
175:Symptoms may include pain,
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233:has occurred to the lower
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1628:Abbreviated Injury Scale
1432:Traumatic aortic rupture
1859:Penetrating head injury
1854:Intracranial hemorrhage
1517:Tracheobronchial injury
1483:lower respiratory tract
1043:10.21037/atm.2018.05.27
786:(3): 695–711, viii–ix.
780:Emerg Med Clin North Am
627:10.21037/jtd.2018.10.76
247:radiofrequency ablation
2055:Subcutaneous emphysema
2014:Volkmann's contracture
1864:Traumatic brain injury
1701:Early appropriate care
1696:Damage control surgery
620:(Suppl 2): S152–S157.
569:10.1186/1471-230X-6-38
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56:Cardiothoracic surgery
1829:Thoracic aorta injury
1789:Diaphragmatic rupture
1633:Injury Severity Score
1603:Trauma triad of death
1522:Diaphragmatic rupture
1437:Thoracic aorta injury
965:Trauma. Fifth Edition
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118:Diaphragmatic rupture
111:15–40% mortality rate
27:Diaphragmatic rupture
2004:Compartment syndrome
1643:Revised Trauma Score
1512:Pulmonary laceration
1452:Myocardial contusion
1202:10.1148/rg.322115082
1163:10.1148/rg.322115082
919:Radiol Clin North Am
526:Diaphragmatic hernia
165:diaphragmatic hernia
122:diaphragmatic injury
1839:Blunt kidney trauma
1809:Pulmonary contusion
1507:Pulmonary contusion
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289:pulmonary contusion
149:computed tomography
128:) is a tear of the
1953:Spinal cord injury
1912:Penetrating trauma
1779:Soft tissue injury
1471:Myocardial rupture
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1343:External resources
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528:
521:
518:
472:
469:
455:
452:
402:
399:
386:
383:
357:
354:
341:
338:
299:is present. A
276:
273:
254:
251:
227:gunshot wounds
200:
197:
172:
169:
113:
112:
109:
103:
102:
99:
95:
94:
91:
85:
84:
81:
77:
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73:
67:
66:
53:
47:
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38:
37:
29:
28:
20:
15:
9:
6:
4:
3:
2:
2093:
2082:
2079:
2078:
2076:
2061:
2060:Wound healing
2058:
2056:
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2048:
2044:
2041:
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2036:
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2034:
2031:
2027:
2024:
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2019:
2015:
2012:
2011:
2010:
2007:
2005:
2002:
2000:
1997:
1995:
1992:
1991:
1989:
1987:Complications
1985:
1975:
1972:
1970:
1967:
1966:
1964:
1960:
1954:
1951:
1949:
1946:
1944:
1943:Facial trauma
1941:
1939:
1936:
1934:
1931:
1930:
1928:
1924:
1918:
1915:
1913:
1910:
1908:
1907:Gunshot wound
1905:
1903:
1902:Electrocution
1900:
1898:
1895:
1893:
1890:
1888:
1885:
1883:
1880:
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1873:
1865:
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1777:
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1767:
1765:
1764:Bone fracture
1762:
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1750:
1747:
1743:
1733:
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1707:
1706:Trauma center
1704:
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1598:Resuscitation
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1234:
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1190:RadioGraphics
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1151:Radiographics
1148:
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1012:
1010:0-7817-5074-1
1006:
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993:
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989:
987:
985:
976:
974:0-07-137069-2
970:
966:
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949:
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936:
932:
928:
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828:
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619:
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561:
557:
553:
546:
542:
532:
529:
527:
524:
523:
517:
515:
511:
510:bruised heart
507:
503:
499:
495:
491:
487:
477:
471:Other animals
468:
466:
461:
460:Ambroise Paré
449:Ambroise Paré
447:
443:
441:
437:
433:
429:
425:
421:
417:
413:
408:
398:
396:
392:
382:
381:may be used.
380:
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362:
353:
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337:
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331:
326:
317:
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311:
306:
305:pathognomonic
302:
298:
294:
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286:
282:
272:
270:
266:
261:
260:pleural space
250:
248:
244:
243:thoracentesis
240:
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228:
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219:
214:
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206:
196:
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186:
182:
178:
168:
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141:
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131:
127:
123:
120:(also called
119:
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96:
92:
90:
86:
82:
78:
74:
72:
68:
63:
57:
54:
52:
48:
44:
39:
35:
30:
25:
19:
2081:Chest trauma
1938:Chest injury
1897:Crush injury
1887:Blunt trauma
1882:Blast injury
1804:Pneumothorax
1788:
1588:Traumatology
1583:Major trauma
1521:
1492:Pneumothorax
1445:
1425:
1405:, excluding
1403:Chest injury
1350:
1326:
1311:
1296:
1240:
1236:
1226:
1193:
1189:
1183:
1173:– via
1154:
1150:
1140:
1097:
1093:
1033:
1029:
1019:
1000:
964:
922:
918:
912:
890:(1): 26–30.
887:
883:
843:
839:
783:
779:
753:
733:
729:
676:
617:
613:
559:
555:
545:
531:Chest injury
482:
457:
404:
401:Epidemiology
388:
367:
343:
334:Thoracoscopy
322:
297:pneumothorax
278:
256:
205:blunt trauma
202:
174:
161:chest cavity
153:
142:
125:
121:
117:
116:
18:
2009:Contracture
1962:Demographic
1948:Head injury
1794:Flail chest
1716:Trauma team
1414:Cardiac and
846:(1): 81–5.
432:lacerations
412:head injury
281:Chest X-ray
265:ventilation
1917:Stab wound
1799:Hemothorax
1725:Procedures
1684:Principles
1677:Management
1638:NACA score
1612:Assessment
1578:Polytrauma
1571:Principles
1497:Hemothorax
537:References
428:long bones
375:hemothorax
371:laparotomy
330:laparotomy
293:hemothorax
213:iatrogenic
189:epigastric
1875:Mechanism
1769:Degloving
1407:fractures
1360:emerg/136
1352:eMedicine
1257:1740-8261
1210:0271-5333
1114:1078-7496
1052:2305-5847
1036:(18): 5.
636:2072-1439
504:, and/or
458:In 1579,
420:fractures
391:mortality
385:Prognosis
356:Treatment
350:mortality
275:Diagnosis
269:hypoxemia
253:Mechanism
237:or upper
211:, and by
177:orthopnea
159:than the
134:breathing
130:diaphragm
107:Prognosis
98:Treatment
51:Specialty
2075:Category
2033:Embolism
1485:injuries
1480:Lung and
1427:vascular
1419:injuries
1357:med/3487
1265:12718361
1218:22411944
1171:22411944
1132:30216264
1070:30370277
939:16500203
904:18420123
860:17650700
800:17826213
750:15097979
654:30906579
588:17132174
520:See also
340:Location
181:coughing
71:Symptoms
1815:Cardio
1123:6170143
1061:6186556
645:6389556
579:1687187
502:omentum
494:stomach
454:History
434:of the
422:of the
325:CT scan
239:abdomen
101:Surgery
1926:Region
1850:Neuro
1753:Injury
1593:Triage
1564:Trauma
1263:
1255:
1216:
1208:
1169:
1130:
1120:
1112:
1068:
1058:
1050:
1007:
971:
937:
902:
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748:
684:
652:
642:
634:
586:
576:
562:: 38.
506:uterus
498:spleen
440:spleen
430:, and
424:pelvis
199:Causes
185:sepsis
83:Trauma
80:Causes
58:
1785:Resp
1447:heart
1333:S27.8
1328:ICD-O
1322:862.1
1307:S27.8
486:liver
436:liver
416:aorta
346:liver
235:chest
145:X-ray
43:X-ray
1892:Burn
1760:MSK
1317:9-CM
1261:PMID
1253:ISSN
1214:PMID
1206:ISSN
1167:PMID
1128:PMID
1110:ISSN
1066:PMID
1048:ISSN
1005:ISBN
969:ISBN
935:PMID
900:PMID
856:PMID
796:PMID
746:PMID
682:ISBN
650:PMID
632:ISSN
584:PMID
438:and
426:and
245:and
225:and
223:Stab
126:tear
2043:fat
2038:air
1835:GI
1313:ICD
1298:ICD
1245:doi
1198:doi
1159:doi
1118:PMC
1102:doi
1056:PMC
1038:doi
927:doi
892:doi
848:doi
788:doi
738:doi
640:PMC
622:doi
574:PMC
564:doi
295:or
124:or
41:An
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