15. Traumatic diaphragm injuries

Traumatic diaphragm injuries may occur due to blunt or penetrating traumas of the thorax and abdomen. Of all diaphragm injuries, 75% are associated with blunt traumas, and 25% are due to penetrating traumas. Their incidence varies between 1 and 5%. The right diaphragm is protected against injuries by the liver, and so diaphragm ruptures are five times more common on the left side than on the right side [9, 39, 40].

Conventional radiological investigations that can be performed when the patient is stabilized are the most important diagnostic methods. Diaphragm elevations, basal atelectasis, loss and/ or irregularity of diaphragm borders, blunting of the costophrenic sinus and abnormal nasogastric tube positioning are among the key findings in a direct lung radiography. Furthermore, a fluoroscopy can indicate whether or not the diaphragm is immobile, or can display paradoxical movements [41, 42].

CT is also important for the identification of concomitant injuries, such as those to the liver, spleen or kidneys. The CT findings of a diaphragm injury include the interruption of diaphragm continuity, visualization of a defect in the diaphragm, herniation of the abdominal organs into thoracic cavity, abnormal positioning of the nasogastric tube, direct contact of the posterior of the ribs with such organs as the liver and stomach, and injuries that progress from one side of the diaphragm towards the other side [9, 41, 42]. In cases where, despite all investigations, there is still suspicion, a thoracoscopy and/or laparoscopy can be performed during the same session.
