Diaphragmatic Trauma
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Basics
Description
- Penetrating injury:
- Violation of the diaphragm by penetrating object (most commonly stab and gunshot wounds)
- May involve any portion of diaphragm
- Smaller defect compared with blunt injuries (more likely to be missed)
- Blunt injury:
- Increased intra-abdominal or intrathoracic pressure is transmitted to diaphragm, causing rupture
- Injuries are more commonly left-sided:
- Left hemidiaphragm has posterolateral embryologic point of weakness
- Right hemidiaphragm is protected by liver
- Injuries are larger than with penetrating injury (frequently between 5–15 cm in length)
- Diaphragmatic defects do not heal spontaneously because of pleuroperitoneal pressure gradient:
- May exceed 100 cm H2O during maximal respiratory effort
- Promotes herniation of abdominal contents through tear in diaphragm
Epidemiology
Incidence
Uncommon; <1% of all traumatic injuries
Etiology
- Lateral torso impact is 3 times more likely to result in ipsilateral diaphragmatic rupture than frontal impact
- Suspect diaphragmatic injury:
- Penetrating trauma to thoracoabdominal area
- Injuries that cross plane of the diaphragm, which can extend up to the fourth rib
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Basics
Description
- Penetrating injury:
- Violation of the diaphragm by penetrating object (most commonly stab and gunshot wounds)
- May involve any portion of diaphragm
- Smaller defect compared with blunt injuries (more likely to be missed)
- Blunt injury:
- Increased intra-abdominal or intrathoracic pressure is transmitted to diaphragm, causing rupture
- Injuries are more commonly left-sided:
- Left hemidiaphragm has posterolateral embryologic point of weakness
- Right hemidiaphragm is protected by liver
- Injuries are larger than with penetrating injury (frequently between 5–15 cm in length)
- Diaphragmatic defects do not heal spontaneously because of pleuroperitoneal pressure gradient:
- May exceed 100 cm H2O during maximal respiratory effort
- Promotes herniation of abdominal contents through tear in diaphragm
Epidemiology
Incidence
Uncommon; <1% of all traumatic injuries
Etiology
- Lateral torso impact is 3 times more likely to result in ipsilateral diaphragmatic rupture than frontal impact
- Suspect diaphragmatic injury:
- Penetrating trauma to thoracoabdominal area
- Injuries that cross plane of the diaphragm, which can extend up to the fourth rib
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