Diaphragmatic trauma

Background

• Associated with penetrating trauma to lower chest/upper abdomen
  • Rarely caused by blunt trauma
• If missed can lead to herniation of viscera and to a tension enterothorax
• Most commonly left sided

Clinical Features

• SOB
• Diminished breath sounds on side of rupture

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Diagnosis

• CT C/A/P with contrast
• Pass OG tube and check if tube curves up from abdomen into the chest
• Upper GI series (looking for viscera in the chest)

Disposition

• Admit

See Also

• Thoracic Trauma