Diagnosing penetrating diaphragmatic injuries: CT scan is valuable but not reliable.

Abdominal Injuries / diagnostic imaging Diaphragm / diagnostic imaging Humans Retrospective Studies Thoracic Injuries / diagnostic imaging Tomography, X-Ray Computed Wounds, Nonpenetrating Wounds, Penetrating / diagnostic imaging
Ct scan Diagnosis Diaphragm injury Penetrating trauma

Journal

Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040

Informations de publication

Date de publication:
Jan 2022
Historique:
received: 24 05 2021
revised: 25 08 2021
accepted: 10 09 2021
pubmed: 6 10 2021
medline: 11 1 2022
entrez: 5 10 2021
Statut: ppublish

Résumé

The diagnosis of penetrating isolated diaphragmatic injuries can be challenging because they are usually asymptomatic. Diagnosis by chest X-ray (CXR) is unreliable, while CT scan is reported to be more valuable. This study evaluated the diagnostic ability of CXR and CT in patients with proven DI. Single center retrospective study (2009-2019), including all patients with penetrating diaphragmatic injuries (pDI) documented at laparotomy or laparoscopy with preoperative CXR and/or CT evaluation. Imaging findings included hemo/pneumothorax, hemoperitoneum, pneumoperitoneum, elevated diaphragm, definitive DI, diaphragmatic hernia, and associated abdominal injuries. 230 patients were included, 62 (27%) of which had isolated pDI, while 168 (73%) had associated abdominal or chest trauma. Of the 221 patients with proven DI and preoperative CXR, the CXR showed hemo/pneumothorax in 99 (45%), elevated diaphragm in 51 (23%), and diaphragmatic hernia in 4 (1.8%). In 86 (39%) patients, the CXR was normal. In 126 patients with pDI and preoperative CT, imaging showed hemo/pneumothorax in 95 (75%), hemoperitoneum in 66 (52%), pneumoperitoneum in 35 (28%), definitive DI in 56 (44%), suspected DI in 26 (21%), and no abnormality in 3 (2%). Of the 57 patients with isolated pDI the CXR showed a hemo/pneumothorax in 24 (42%), elevated diaphragm in 14 (25%) and was normal in 24 (42%). Radiologic diagnosis of DI is unreliable. CT scan is much more sensitive than CXR. Laparoscopic evaluation should be considered liberally, irrespective of radiological findings.

Sections du résumé

BACKGROUND BACKGROUND
The diagnosis of penetrating isolated diaphragmatic injuries can be challenging because they are usually asymptomatic. Diagnosis by chest X-ray (CXR) is unreliable, while CT scan is reported to be more valuable. This study evaluated the diagnostic ability of CXR and CT in patients with proven DI.
METHODS METHODS
Single center retrospective study (2009-2019), including all patients with penetrating diaphragmatic injuries (pDI) documented at laparotomy or laparoscopy with preoperative CXR and/or CT evaluation. Imaging findings included hemo/pneumothorax, hemoperitoneum, pneumoperitoneum, elevated diaphragm, definitive DI, diaphragmatic hernia, and associated abdominal injuries.
RESULTS RESULTS
230 patients were included, 62 (27%) of which had isolated pDI, while 168 (73%) had associated abdominal or chest trauma. Of the 221 patients with proven DI and preoperative CXR, the CXR showed hemo/pneumothorax in 99 (45%), elevated diaphragm in 51 (23%), and diaphragmatic hernia in 4 (1.8%). In 86 (39%) patients, the CXR was normal. In 126 patients with pDI and preoperative CT, imaging showed hemo/pneumothorax in 95 (75%), hemoperitoneum in 66 (52%), pneumoperitoneum in 35 (28%), definitive DI in 56 (44%), suspected DI in 26 (21%), and no abnormality in 3 (2%). Of the 57 patients with isolated pDI the CXR showed a hemo/pneumothorax in 24 (42%), elevated diaphragm in 14 (25%) and was normal in 24 (42%).
CONCLUSIONS CONCLUSIONS
Radiologic diagnosis of DI is unreliable. CT scan is much more sensitive than CXR. Laparoscopic evaluation should be considered liberally, irrespective of radiological findings.

Identifiants

DOI: 10.1016/j.injury.2021.09.014 PMID: 34607700
pubmed: 34607700
pii: S0020-1383(21)00788-9
doi: 10.1016/j.injury.2021.09.014
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

116-121

Informations de copyright

Copyright © 2021. Published by Elsevier Ltd.

Déclaration de conflit d'intérêts

Declarations of Competing Interest none

Auteurs

Camilla Cremonini (C)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA; General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy. Electronic address: camilla.cremonini@phd.unipi.it.

Meghan R Lewis (MR)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: meghan.lewis@med.usc.edu.

Dominik Jakob (D)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: dj_032@usc.edu.

Elizabeth R Benjamin (ER)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: elizabeth.benjamin@med.usc.edu.

Massimo Chiarugi (M)

General, Emergency and Trauma Surgery Department, Pisa University Hospital, via Paradisa 2, 56124, Pisa, Italy. Electronic address: massimo.chiarugi@med.unipi.it.

Demetrios Demetriades (D)

Division of Trauma, Emergency Surgery and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, C5L100, Los Angeles, CA, 90033, USA. Electronic address: demetrios.demetriades@med.usc.edu.

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Classifications MeSH

questionsmedicales.fr › Plaies et blessures › Traumatismes de l'abdomen › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Appareil locomoteur › Muscles respiratoires › Muscle diaphragme › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Plaies et blessures › Blessures du thorax › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Plaies et blessures › Plaies non pénétrantes › Diagnosing penetrating diaphragmatic injuries:...
questionsmedicales.fr › Plaies et blessures › Plaies pénétrantes › Diagnosing penetrating diaphragmatic injuries:...