Diaphragmatic rupture x ray
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Diaphragmatic rupture Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
X Ray
Initially, diagnosis can be difficult, especially when other severe injuries are present; thus the condition is commonly diagnosed late. Chest X-ray is known to be unreliable in diagnosing diaphragmatic rupture;[1] it has low sensitivity and specificity for the injury. Often another injury such as pulmonary contusion masks the injury on the X-ray film. Half the time, initial X-rays are normal; in most of those that are not, hemothorax or pneumothorax is present. However, there are signs detectable on X-ray films that indicate the injury. On an X-ray, the diaphram may appear higher than normal. Gas bubbles may appear in the chest, and the mediastinum may appear shifted to the side. A nasogastric tube from the stomach may appear on the film in the chest cavity; this sign is pathognomonic for diaphragmatic rupture, but it is rare. A contrast medium that shows up on X-ray can be inserted through the nasogastric tube to make a diagnosis. The X-ray is better able to detect the injury when taken from the back with the patient upright, but this is not usually possible because the patient is usually not stable enough; thus it is usually taken from the front with the patient lying supine.Positive pressure ventilation helps keep the abdominal organs from herniating into the chest cavity, but this also can prevent the injury from being discovered on an X-ray.
- Specific diagnostic findings of diaphragmatic tears on chest radiographs include the following:
- Intrathoracic herniation of a hollow viscus (stomach, colon, small bowel) with or without focal constriction of the viscus at the site of the tear (collar sign)
- Visualization of a nasogastric tube above the hemidiaphragm on the left side.
References
- ↑
Karmy-Jones R, Jurkovich GJ (2004). "Blunt chest trauma". Current Problems in Surgery. 41 (3): 211–380. doi:10.1016/j.cpsurg.2003.12.004. PMID 15097979.
A sudden increase in the pressure gradient between the pleural and peritoneal cavities that occurs with high-speed blunt trauma will lead to disruptions of the diaphragm... This same pleuroperitoneal pressure gradient will also promote migration of intraperitoneal structures into the pleural space after disruption has occurred. Once the viscera have been displaced into the pleural space, both cardiovascular and respiratory functions are compromised.
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