- 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
Uncommon; <1% of all traumatic injuries
- 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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Schaider, Jeffrey J., et al., editors. "Diaphragmatic Trauma." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma.
Diaphragmatic Trauma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma. Accessed June 4, 2023.
Diaphragmatic Trauma. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma
Diaphragmatic Trauma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 04]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diaphragmatic Trauma ID - 307469 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307469/all/Diaphragmatic_Trauma PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -