The diaphragm is the arched, flat muscular structure that divides the thorax from the abdominal cavity. A diaphragm injury (Diaphragmatic Rupture) is a tear to the diaphragm muscle across the bottom of the ribcage. Although this type of injury is uncommon, 80-90% of these injuries are caused by motor vehicle accidents. Other injuries, such as gunshots, stab wounds, falls and crushing injuries, are rare; however, major damage to the diaphragm will cause injuries to adjacent organs. Patients with large diaphragmatic defects have critical problems shortly after trauma as a result cardiorespiratory function associated with large herniation of abdominal contents to the pleural space. Because the right side of the diaphragm is well-protected by the liver, 64 to 87% of the tears are commonly on the left side. A diaphragm injury is a medical emergency, and 911 should be called immediately. Prognosis is good if the injury is managed as soon as possible. Early death is often due to other injuries.
Severe diaphragm injuries/ruptures caused by blunt or penetrating injuries can also present several years later with herniation, strangulation, and eventual rupture of abdominal viscera into the pleural cavity. These penetrating injuries may often be undiagnosed and overlooked in initial assessment because patients may be asymptomatic or have vague symptoms, which may cause diagnosis to be delayed. Patients will show signs of decreased or inadequate ventilation and worsening respiratory function caused by herniation of abdominal organs into the chest cavity. Other symptoms may include chest pains and difficulty breathing. This is a medical emergency and 911 should be called immediately.
Diaphragm injuries (Diaphragmatic Ruptures) are best managed by an interprofessional team that includes a cardiologist, general surgeon, thoracic surgeon, and trauma surgeon. Once diagnosed, the only treatment for a diaphragm tear is surgery. Diagnostic methods include chest X-rays, an upper GI contrast study, fluoroscopic evaluation of diaphragmatic motion, ultrasound (US), computed tomography (CT) scan, laparoscopy, and video-assisted thoracic surgery.
References
Lee, K., Kashyap, S., & Atherton, N.S. (2020). Diaphragm Injury. https://www.ncbi.nlm.nih.gov/books/NBK482207/
Mybox. (2020). [Illustration]. Diaphragm Human Respiratory System Anatomy For Medical Concept 3D Illustration. https://www.shutterstock.com/image-illustration/diaphragm-human-respiratory-system-anatomy-medical-1849680343
Simon, L. V., Lopez, R. A., & Burns, B. (2020). Diaphragm Rupture. https://www.ncbi.nlm.nih.gov/books/NBK470214/