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

Abstract

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:

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:

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:

Radiologic diagnosis of DI is unreliable. CT scan is much more sensitive than CXR. Laparoscopic evaluation should be considered liberally, irrespective of radiological findings.

• Authors: Camilla Cremonini, Meghan R Lewis, Dominik Jakob, Elizabeth R Benjamin, Massimo Chiarugi, Demetrios Demetriades
• Journal: Injury (Injury) Vol. 53 Issue 1 Pg. 116-121 (Jan 2022) ISSN: 1879-0267 [Electronic] Netherlands
• PMID: 34607700 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Ltd.

Topics

• Abdominal Injuries (diagnostic imaging)
• Diaphragm (diagnostic imaging)
• Humans
• Retrospective Studies
• Thoracic Injuries (diagnostic imaging)
• Tomography, X-Ray Computed
• Wounds, Nonpenetrating
• Wounds, Penetrating (diagnostic imaging)