Traumatic injuries of the diaphragm

A. S. Estrera, M. R. Platt, L. J. Mills

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Traumatic injury of the diaphragm is not an infrequent occurrence. With the rise in violence and increasing use of automobiles, more diaphragmatic injuries may be seen, especially in inner-city hospitals. Sixty-six cases from this institution within the last five years were reviewed. Of these there were 41 penetrating injuries and 23 secondary to blunt trauma. Two cases were surgically induced following a difficult decortication for pleuropulmonary tuberculosis. There were ten deaths (15 percent mortality). All deaths were related to the severity of associated injuries. In addition, we analyzed 307 patients with multiple injuries who were dead on arrival and were autopsied by the county medical examiners in a 24-month period. Of the 307 autopsied cases, 16 (5.2 percent) had ruptured diaphragms. Interestingly, all but one of these cases were associated with thoracic aortic injuries. Diagnoses of penetrating diaphragmatic injuries were made during exploration of other injuries. In blunt diaphragmatic rupture, a high index of suspicion is most important in the diagnosis. In 10 of 23 blunt injuries, visceral herniation was noted on initial x-ray films. In four, follow-up films several hours to a day later showed loops of bowel in the chest. In nine cases, there were no apparent visceral herniations on initial films, and in these, the diagnosis was made during surgery for other indications. The surgical approach to diaphragmatic injuries is individualized. Acute left-sided injuries are best approached through the abdomen. Acute right-sided injuries and all chronic injuries should be approached through the chest.

Original languageEnglish (US)
Pages (from-to)306-313
Number of pages8
JournalChest
Volume75
Issue number3
StatePublished - 1979

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Diaphragm
Wounds and Injuries
Thorax
Coroners and Medical Examiners
Automobiles
Thoracic Injuries
Nonpenetrating Wounds
Multiple Trauma
Urban Hospitals
Motion Pictures
Violence
Abdomen
Rupture
Tuberculosis
X-Rays
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Estrera, A. S., Platt, M. R., & Mills, L. J. (1979). Traumatic injuries of the diaphragm. Chest, 75(3), 306-313.

Traumatic injuries of the diaphragm. / Estrera, A. S.; Platt, M. R.; Mills, L. J.

In: Chest, Vol. 75, No. 3, 1979, p. 306-313.

Research output: Contribution to journalArticle

Estrera, AS, Platt, MR & Mills, LJ 1979, 'Traumatic injuries of the diaphragm', Chest, vol. 75, no. 3, pp. 306-313.
Estrera AS, Platt MR, Mills LJ. Traumatic injuries of the diaphragm. Chest. 1979;75(3):306-313.
Estrera, A. S. ; Platt, M. R. ; Mills, L. J. / Traumatic injuries of the diaphragm. In: Chest. 1979 ; Vol. 75, No. 3. pp. 306-313.
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