Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma.
Abdominal Injuries ; Diaphragm* ; Hernia* ; Humans ; Spondylitis, Ankylosing*

OBJECTIVEThe objective was to evaluate the protective effects of dexmedetomidine (DEX), a selective agonist of α2-adrenergic receptor, on sepsis-induced diaphragm injury and the underlying molecular mechanisms.

DATA SOURCESThe data used in this review were mainly from PubMed articles published in English from 1990 to 2015.

STUDY SELECTIONClinical or basic research articles were selected mainly according to their level of relevance to this topic.

RESULTSSepsis could induce severe diaphragm dysfunction and exacerbate respiratory weakness. The mechanism of sepsis-induced diaphragm injury includes the increased inflammatory cytokines and excessive oxidative stress and superfluous production of nitric oxide (NO). DEX can reduce inflammatory cytokines, inhibit nuclear factor-kappaB signaling pathways, suppress the activation of caspase-3, furthermore decrease oxidative stress and inhibit NO synthase. On the basis of these mechanisms, DEX may result in a shorter period of mechanical ventilation in septic patients in clinical practice.

CONCLUSIONSBased on this current available evidence, DEX may produce extra protective effects on sepsis-induced diaphragm injury. Further direct evidence and more specific studies are still required to confirm these beneficial effects.

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries. We successfully treated the impalement injury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a collection of fluid in the abdominal cavity. The conservative management plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a patient with less invasive techniques yielded a good outcome. This management option may be considered as an alternative for open surgery for hemodynamically stable patients in experienced centres.
Abdominal Injuries ; therapy ; Adolescent ; Diaphragm ; injuries ; Humans ; Liver ; injuries ; Male ; Minimally Invasive Surgical Procedures ; Thoracic Injuries ; therapy ; Wounds, Penetrating ; therapy

The abdomen includes the organs and viscera below the diaphragm and above the pelvic girdle. Although there is little bony structure to protect these organs from blunt impact, injuries to this region is relatively rare. Like the thorax, the abdomen can be the site of injuries sustained by inner parts of the car and restraint systems. As far as the crucial organs are concerned, the liver, spleen and kidneys are most frequently injured, and it seems to be the most serious and life-threatening. Injury mechanisms of the abdomen are thought to be primarily the result of deformation or penetration of the abdominal contents along with significant force or pressure generation in the deformed organs. In addition, solid organs, such as liver may undergo severe damage due to pressure generation alone at high impact velocities. There is evidence to show that these organs are viscoelastic, that the rate of loading is a crucial factor in injury causation, and that a compressive stress of 310kPa(45psi) will cause a superficial liver injury. Regarding dynamic response of the abdomen, the problem is complicated by the fact that there is a variety of surface geometries and component materials that can impact the abdominal area in a vehicle crash environment. In side impacts, however, the surface such as doors and armrests are somewhat well-defined, and dynamic load-deflection response curves do exist to a limited extent.
Abdomen ; Abdominal Injuries* ; Accidents, Traffic* ; Diaphragm ; Kidney ; Liver ; Spleen ; Thorax ; Viscera

A 62-year-old woman with frequent occurrence of symptomatic atrial tachycardia with a foci located at the root of the upper crista terminalis was found to have right diaphragm paresis after receiving a total of 8 radiofrequency energy deliveries (40-60 W, 50-60ºC) and a total duration of 540 seconds of ablation therapy (7Fr 8 mm deflectable ablation catheter). The right diaphragm paresis remained resolved up to 14 months after the procedure as confirmed by repeated chest X-rays.
Catheter Ablation ; adverse effects ; Diaphragm ; injuries ; Female ; Humans ; Middle Aged ; Tachycardia, Supraventricular ; therapy

Traumatic diaphragmatic rupture (TDR) is uncommon, and may be associated with other severe life-threatening injuries after blunt trauma. Recently, we experienced a right-sided TDR patient with other multiple life-threatening injuries. A 59-year-old female inflicted with a right-sided TDR accompanied by herniated liver was treated with thoracoscopic exploration. We successfully managed associated life-threatening injuries such as traumatic brain injury and pelvic bone fractures with bleeding, simultaneously.
Brain Injuries ; Diaphragm ; Female ; Hemorrhage ; Humans ; Liver ; Middle Aged ; Pelvic Bones ; Rupture* ; Thoracoscopes

Pneumothorax and pneumomediastinum can cause pneumoperitoneum, which does not require surgery. There are unverified theories pertaining to how air passes through the diaphragm. We report a case of pneumoperitoneum caused by blunt chest injury that was successfully managed with conservative care. Although the pneumoperitoneum was caused by thoracic injury, we believe that the air did not pass through the diaphragm, but instead came from the abdominal wall, as in subcutaneous emphysema.
Abdominal Wall ; Diaphragm ; Mediastinal Emphysema ; Pneumoperitoneum* ; Pneumothorax ; Subcutaneous Emphysema* ; Thoracic Injuries* ; Thorax*

In patients with cervical spine injuries, respiratory function requires careful attention. Voluntary respiratory control is usually possible with lesions below C4 level although paralysis of the abdominal musculature results in a decreased ability to cough and to clear secretions, which may later lead to respiratory insufficiency. Therefore, injuries above C5 usually necessitate long term mechanical ventilation. Even though weaning criteria are not definitive for the quadriplegic patient, M-mode ultrasonography of the diaphragm may be useful in identifying patients at high risk of difficulty weaning. Diaphragmatic dysfunction (vertical excursion < 10 mm or paradoxical movements) results in frequent early and delayed weaning failures. We present our clinical experience with successful weaning by using M-mode ultrasonography and a cough-assist device for secretion clearance after extubation in a quadriplegic patient undergoing C2-4 spine laminoplasty.
Cough ; Diaphragm ; Humans ; Paralysis ; Quadriplegia ; Respiration, Artificial ; Respiratory Insufficiency ; Spinal Cord ; Spinal Cord Injuries ; Spine ; Ventilator Weaning ; Weaning

Tension viscerothorax (gastrothorax) is rare life-threatening disease which is caused by air trapped in viscera. A distended viscera in the hemi-thorax shifts the mediastinal structures and causes extra-cardiac obstructive shock. A defective diaphragm is caused by abdominal trauma or a congenital anomaly. Traumatic diaphragmatic injury can be missed until herniation develops several years after blunt trauma. In our case, a 10-year old boy developed hemodynamic compromise in the emergency department. Three years earlier, he had suffered blunt abdominal trauma during a pedestrian traffic accident, but there was no evidence of diaphragmatic injury at that time. He was successfully resuscitated by gastric decompression and an emergent thoracic operation. The operation finding revealed a traumatic diaphragmatic injury. Tension viscerothorax is a rare, but catastrophic, condition, so we suggest that addition of tension viscerothorax to the Advanced Trauma and Life Support (ATLS) guidelines may be helpful.
Abdominal Injuries ; Accidents, Traffic ; Child ; Decompression ; Diaphragm ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Male ; Rupture* ; Shock ; Viscera ; Wounds, Nonpenetrating

PURPOSE: Traumatic diaphragmatic rupture resulting from blunt trauma is usually severe. However, it is often overlooked during initial evaluation because there are no characteristic signs and symptoms. Thus, this study aimed to determine the clinical characteristics of diaphragmatic rupture caused by blunt trauma and investigate the diagnostic usefulness of diaphragmatic height index (DHI) measured using chest radiographs. METHODS: The cohort comprised patients who were admitted due to diaphragmatic rupture from blunt trauma. Patients were divided into 2 groups; the control group comprised patients with blunt trauma who were matched for age, sex, and Injury Severity Score, while the DHI group comprised patients with diaphragmatic rupture from blunt trauma. Receiver operating characteristic curve was used to determine the cutoff value of DHI for diaphragmatic injury. The sensitivity, specificity, predictability, accuracy, and likelihood ratio of the cutoff were then determined. RESULTS: A total of 60 patients were confirmed to have diaphragmatic rupture. The mean DHI in patients with diaphragmatic rupture on the right and left side were both significantly different compared to that in the control group. A DHI cutoff value of >1.31 showed 71% sensitivity and 87% specificity for diagnosing right diaphragmatic rupture, while a cutoff value of <0.43 showed 87% sensitivity and 76% specificity for diagnosing left diaphragmatic rupture. CONCLUSION: DHI can be useful in the diagnosis of diaphragmatic rupture. DHI as determined using chest radiographs in patients with blunt abdominal trauma, particularly in those ineligible for diagnostic work-up, may help in the diagnosis of diaphragmatic rupture.
Abdominal Injuries ; Cohort Studies ; Diagnosis ; Diaphragm ; Humans ; Injury Severity Score ; Multiple Trauma ; Radiography, Thoracic ; ROC Curve ; Rupture ; Sensitivity and Specificity