Ver el código de «Diaphragmatic trauma»

==Background==
[[File:1113 The Diaphragm.jpg|thumb|Diaphragm anatomy from inferior view.]]
[[File:Gray530.png|thumb|Left pleura cavity and diaphram (viewed from left).]]
[[File:Body Cavities Frontal view labeled 2.jpg|thumb|The pericardial cavity in this image is labeled d and is part of the inferior mediastium. Here we can see its relation to the superior mediastinum a, the pleural cavities c, and the diaphragm e.]]
*Associated with penetrating or blunt trauma to lower [[thoracic trauma|chest]]/[[abdominal trauma|upper abdomen]]
**~65% from penetrating, 35% from blunt<ref>National Trauma Data Base. American College of Surgeons 2000-2004. https://ntdbdatacenter.com/ (Accessed on January 01, 2021).</ref>
*If missed, can lead to herniation of viscera and tension enterothorax
*Most commonly left sided
*Majority will have other injuries which can mask symptoms of diaphragm injury
*75% of the time occurs on the left side; the liver is protective on the right side
*Presentation can be delayed months to years after the initial trauma

==Clinical Features==
*[[abdominal pain|Upper abdominal]]/[[chest pain|lower chest pain]]
*[[Shortness of breath]]
*Diminished breath sounds on side of rupture
*Kehr Sign: shoulder pain from referred diaphragm pain

==Differential Diagnosis==
{{Thoracic trauma DDX}}
{{Abdominal trauma DDX}}

==Evaluation==
[[File:Diaphragmatic rupture spleen herniation.jpg|thumb|[[CXR]] of diaphragmatic rupture with spleen herniation.]]
[[File:PMC5098930 poljradiol-81-522-g003.png|thumb|Coronal reformatted CT image shows constriction of the herniated stomach at the level of a ruptured diaphragm (collar sign) after blunt trauma.]]
[[File:PMC5098930 poljradiol-81-522-g002.png|thumb|CT showing left hemidiaphragmatic rupture with a "dangling diaphragm
 sign and herniation of the stomach (confirmed on surgery).]]
*[[CXR]] may show visceral herniation
**Poorly sensitive
*CT chest/abdomen/pelvis with contrast may better detect smaller herniations (roughly 82% sensitive and 88% specific) <ref> Yucel, M et al. Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: The role of multislice computed tomography. Injury. 2015 Sep;46(9):1734-7. </ref>
**"Collar sign"
***waist-like constriction of abdominal viscera
*MRI better evaluates the diaphragm itself in stable patients in whom the diagnosis is unclear
*Surgical exploration is ultimately the best diagnostic modality (thoracoscopy vs laparoscopy vs ex-lap depending on concurrent injuries)
*Thoracoscopy
*Laparoscopy

==Management==
*[[NG tube]] decompression
*Surgery is required to fix the defect

==Disposition==
*Admit

==See Also==
*[[Thoracic Trauma]]

==References==
<references/>

[[Category:Trauma]]
[[Category:Pulmonary]]