International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
Bootstrap Slider

Indexed and Abstracted in: Crossref, CAS Abstracts, Publons, CiteFactor, Open J-Gate, ROAD, Indian Citation Index (ICI), Indian Journals Index (IJINDEX), Internet Archive, IP Indexing, Google Scholar, Scientific Indexing Services, Index Copernicus, ResearchBib, Science Central, Revistas Medicas Portuguesas, EBSCO, BOAI, SOROS, NEWJOUR, ResearchGATE, Ulrich's Periodicals Directory, DocStoc, PdfCast, getCITED, SkyDrive, Citebase, e-Print, WorldCat (World's largest network of library content and services), Electronic Journals Library by University Library of Regensburg, SciPeople.

Search Articles

Track manuscript

Readers around the world

Full Html

IJCRR - Vol 07 Issue 07, April, 2015

Pages: 45-47

Date of Publication: 30-Nov--0001


Print Article   Download XML  Download PDF

IMAGING IN TRAUMATIC DIAPHRAGMATIC RUPTURE - A DIAGNOSTIC DILEMMA

Author: Skandesh B. M., Arjun Prakash, Shama Shetty, Vinay Kumar D. P.

Category: Healthcare

Abstract:Case report: We report a rare case of traumatic diaphragmatic rupture with chest radiology and Computed tomography(CT) findings in whom emergency laparotomy was performed resulting in successful repair of diaphragmatic injury. Discussion: Traumatic diaphragmatic rupture occurs in patients who sustain blunt and penetrating thoracoabdominal injuries. The most common herniated viscera are the stomach and colon on the left side and the liver on the right side. Specific signs in X-ray and Compute tomography (CT) will help in early diagnosis.
Conclusion:
Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. Early diagnosis
and repair of diaphragmatic tears is desirable. Clinical examination coupled with meticulous radiological examinations like
X-ray and Computed tomography(CT) will help in early diagnosis.

Keywords: Trauma, Diaphragm, Rupture, Blunt injury

Full Text:

INTRODUCTION

Blunt diaphragmatic ruptures are difficult to diagnose at initial presentation because of non-specific clinical features. However, these injuries do not resolve spontaneously; therefore, it warrants timely management. If the diagnosis is missed, patients may develop intrathoracic visceral herniation and strangulation, with a morbidity and mortality rate of up to 50%.1 Although chest radiographs are recommended for all patients after major trauma, chest radiography is insensitive in depicting diaphragmatic rupture, with sensitivity of 46% for left-sided ruptures and 17% for right-sided ruptures.2 CT is the imaging modality of choice in the evaluation of severe blunt abdominal trauma. CT has a sensitivity of 61-71% and a specificity of 87-100% as an aid in the diagnosis of acute traumatic diaphragmatic rupture.3

CASE REPORT

A 40-year-old man was brought to the emergency department after sustaining blunt thoracoabdominal trauma after a motor vehicle injury. The patient complained of acute shortness of breath. On examination, there was mild tachypnea and tachycardia. General examination of the patient was unremarkable and respiratory examination of the patient revealed reduced air entry with decreased chest expansion in the left hemithorax and auscultation of bowel sounds in the left lower chest. Preliminary routine investigations were normal and the patient’s chest x-ray (postero-anterior view in erect position) revealed tracheal and mediastinal shift to the right and fundal gas shadow in left hemithorax. Left hemidiphragm could not be well outlined. Definite defect of diaphragm could not be appreciated well on x-ray. The x-ray showed no evidence of rib fractures or pneumothorax. Plain CT scan of thorax was advised to the patient which revealed focal defect of left diaphragm measuring 6.1x5.4cm (Anteroposterior x Transverse) with herniation of stomach and proximal half of body of the stomach into the left hemithorax with waist-like constriction of the herniating stomach at the site of the diaphragmatic tear (collar sign) causing mass effect in the form of tracheal and mediastinal shift to the right side associated with minimal pneumothorax. The herniated stomach was lying in a dependent position against the posterior ribs (Dependent viscera sign) as the patient was scanned in supine position. Patchy ground glass opacities were noted involving the apicoposterior segment of left upper lobe suggesting contusion. The patient underwent emergency laparotomy for repair of his injury. Successful repair of the diaphragmatic injury was achieved.

DISCUSSION

Traumatic diaphragmatic rupture can be due to blunt, penetrating injuries or iatrogenic causes. It occurs in up to 6% of patients after major blunt trauma.4 The most common cause is motor vehicle collisions. Most cases occur in young men after motor vehicle accidents.5 The most common herniated viscera are the stomach and colon on the left side and the liver on the right side. Injuries to the left hemidiaphragm occur three times more frequently than injuries to the right side following blunt trauma, possibly due to a buffering effect of the liver on the right hemidiaphragm. Most ruptures are longer than 10 cm and occur at the posterolateral aspect of the hemidiaphragm between the lumbar and intercostal attachments, spreading radially.6 Specific diagnostic findings of diaphragmatic tears on chest radiographs include intrathoracic herniation of a hollow viscus with or without focal constriction of the viscus at the site of the tear (collar sign) and visualization of a nasogastric tube above the hemidiaphragm on the left side. Other findings include elevation of the hemidiaphragm, distortion or obliteration of the outline of the hemidiaphragm, and contralateral shift of the mediastinum. CT findings suggestive of hemidiaphragmatic tears are direct discontinuity of the hemidiaphragm which is the most sensitive sign of rupture (sensitivity of 73% and a specificity of 90%), 7 intrathoracic herniation of abdominal contents( has a sensitivity of 55% and a specificity of 100%). Another frequently diagnosed sign is the collar sign, a waist like constriction of the herniating hollow viscus at the site of the diaphragmatic tear (sensitivity of 36% ). The dependent viscera sign is an additional sign.8 When a patient with a ruptured diaphragm lies supine at CT examination, the herniated viscera (bowel or solid organs) are no longer supported posteriorly by the injured diaphragm and fall to a dependent position against the posterior ribs and consequently, the dependent viscera sign is present if the upper one-third of the liver abuts the posterior ribs on the right side or if the stomach, spleen, or bowel abuts the posterior ribs on the left side. Indirect signs are hemothorax and hemoperitoneum. Complications include gastrointestinal strangulation and gastric volvulus.

DIFFERENTIAL DIAGNOSIS

• Congenital hernias (Bochdalek and Morgagni),

• Diaphragmatic eventration

• Motion artifacts due to respiratory movement decrease the quality of multiplanar reformation images and can mimic a diaphragmatic rupture, especially on the right side with pseudoherniation of the liver

CONCLUSION

Diaphragmatic injuries are rarely encountered in clinical practice and can be fatal if early diagnosis and treatment is delayed. Imaging studies are pivotal in making an accurate and timely diagnosis. A comprehensive knowledge of imaging features coupled with keen observation is required for rapid diagnosis and management.

ACKNOWLEDGEMENTS

Authors acknowledge Superintendent, Dr Manohar and Principal Dr Shivaramu for granting us permission to publish the case report. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

1. Drews JA, Mercer EC, Benfield JR. Acute diaphragmatic injuries. Ann Thorac Surg 1973; 16:67-78.

2. Gelman R, Mirvis SE, Gens D. Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR 1991; 156:51-57.

3. Killeen KL, Mirvis SE, Shanmuganathan K. Helical CT of diaphragmatic rupture caused by blunt trauma. AJR 1993; 173:1611-1616.

4. Ward RE, Flynn TC, Clark WP. Diaphragmatic disruption secondary to blunt abdominal trauma. J Trauma 1981; 21:35-38.

5. Weincek RG Jr, Wilson RF, Steiger Z. Acute injuries of the diaphragm. J Thorac Cardiovasc Surg 1986; 92:989-993.

6. Kuhlman JE, Pozniak MA, Collins J, Knisely BL. Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. RadioGraphics 1998; 18:1085-1106.

7. Murray JG, Caoili E, Gruden JF, et al. Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol 1996; 166:1035- 1039.

8. Bergin D, Ennis R, Keogh C, et al. The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol 2001; 177:1137-1140.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

SCOPUS (2014, 2019, 2020, 2021 (Till June) currently under re-evaluation)

COPE guidelines for Reviewers


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
Egg a day tied to lower risk of heart disease
88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


RSS feed

Indexed and Abstracted in


Antiplagiarism Policy: IJCRR strongly condemn and discourage practice of plagiarism. All received manuscripts have to pass through "Plagiarism Detection Software" test before forwarding for peer review. We consider "Plagiarism is a crime"

IJCRR Code of Conduct: We at IJCRR voluntarily adopt policies on Code of Conduct, and Code of Ethics given by OASPA and COPE. To know about IJCRRs Code of Conduct, Code of Ethics, Artical Retraction policy, Digital Preservation Policy, and Journals Licence policy click here

Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



Company name

International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

Contact

148, IMSR Building, Ayurvedic Layout,
        Near NIT Complex, Sakkardara,
        Nagpur-24, Maharashtra State, India

editor@ijcrr.com

editor.ijcrr@gmail.com


Copyright © 2021 IJCRR. Specialized online journals by ubijournal .Website by Ubitech solutions