Traumatic diaphragmatic injuries: spectrum of radiographic findings.
Shackleton KL, Stewart ET, Taylor AJ
Traumatic diaphragmatic injuries are usually caused by blunt trauma
or penetrating injuries. The diagnosis may be delayed due
to confusing clinical and radiographic findings. According to the results
of a review of 25 cases, the diagnosis of diaphragmatic
injury is more often delayed and requires more imaging studies in cases
of blunt trauma than in cases of penetrating injury. Blunt
injury is indicated by asymmetry of a hemidiaphragm or changing diaphragmatic
levels, abdominal contents within the chest,
diaphragmatic paresis, unexplained hemothorax, or multiple upper abdominal
injuries. Penetrating injury is indicated by
hemothorax or a missile or blade trajectory through or near the diaphragm.
Usually, plain radiography shows initial evidence of
traumatic diaphragmatic injury and prompts confirmatory imaging, which
includes computed tomography, magnetic resonance
imaging, barium studies, fluoroscopy, nuclear medicine, and ultrasound.
Nevertheless, the diagnosis of traumatic diaphragmatic
injury may be elusive and often can be made only during exploratory
surgery.
