Fact-sheet: Diaphragm rupture - trauma
Updated on 09/17/2021 at 12:16 PM
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Definition
Traumatic diaphragmatic ruptures are defined as a breach involving all three layers of the diaphragm (pleura, muscle, and peritoneum), potentially allowing herniation of abdominal viscera drawn in by negative thoracic pressure.
Left-sided predominance (70 to 85%) compared with the right side (12 to 24%) in trauma [cushioning role of the liver].
Etiologies:
1) Rupture from blunt trauma (70%):
- Occurring preferentially (80-90% of cases) following a motor vehicle accident or work-related accident.
- Present in 0.8 to 5% of polytrauma patients
- Male predominance, between 30 and 40 years of age
- However, cases have been reported following violent coughing fits, particularly in asthmatic patients.
- Two main injury mechanisms:
Sudden intra-abdominal hyperpressure (secondary to crush injury or severe deceleration) acting predominantly on the left hemidiaphragm.
Crush injury to the thoracic base (sudden deformation of the thoracic floor and traction on the peripheral attachments of the diaphragm)
2) Melee weapon - blade - injury or gunshot wound (30%)
Radiography
- Elevation of abdominal viscera
- Nasogastric tube above the left hemidiaphragm
- Elevated hemidiaphragm - mediastinal shift
CT
- Peripheral detachment of the diaphragm with a "collar" or "hourglass" sign anteriorly
- characteristic apposition of the viscera against the posterior costal surface (dependent viscera sign)
- demonstration of a herniation neck
- abdominal organs herniated into the thorax