TY - JOUR
T1 - Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma
AU - Blaivas, Michael
AU - Brannam, Larry
AU - Hawkins, Michael L
AU - Lyon, Matthew L
AU - Sriram, K.
PY - 2004/11/1
Y1 - 2004/11/1
N2 - Abdominal injury from significant blunt trauma can include injury to bowel, kidneys, liver, and spleen. In approximately 5% of all injuries one of the diaphragms is ruptured. Diaphragmatic rupture may not be easily detected and this can lead to significant morbidity and even mortality. Rupture may be suggested on chest X-ray film especially with abnormal nasogastric tube location but the accuracy of this method is modest only. Abdominal computed tomography is not accurate and magnetic resonance imaging, although very sensitive and specific, is not feasible in most trauma situations. Surgeons have often resorted to exploratory laparotomy or laparoscopy to make the diagnosis. Although not typically part of the basic Focused Abdominal Sonography for Trauma (FAST) examination, ultrasonographic diagnosis of diaphragmatic rupture is possible with little added time to the examination. We present 3 cases of diaphragmatic rupture discovered shortly after the patients' arrival, on initial trauma evaluation with the FAST. A discussion of previous literature and ultrasound technique for diagnosis follows the cases.
AB - Abdominal injury from significant blunt trauma can include injury to bowel, kidneys, liver, and spleen. In approximately 5% of all injuries one of the diaphragms is ruptured. Diaphragmatic rupture may not be easily detected and this can lead to significant morbidity and even mortality. Rupture may be suggested on chest X-ray film especially with abnormal nasogastric tube location but the accuracy of this method is modest only. Abdominal computed tomography is not accurate and magnetic resonance imaging, although very sensitive and specific, is not feasible in most trauma situations. Surgeons have often resorted to exploratory laparotomy or laparoscopy to make the diagnosis. Although not typically part of the basic Focused Abdominal Sonography for Trauma (FAST) examination, ultrasonographic diagnosis of diaphragmatic rupture is possible with little added time to the examination. We present 3 cases of diaphragmatic rupture discovered shortly after the patients' arrival, on initial trauma evaluation with the FAST. A discussion of previous literature and ultrasound technique for diagnosis follows the cases.
KW - Emergency ultrasound
KW - FAST
KW - abdominal ultrasound
KW - blunt abdominal trauma
KW - diaphragmatic rupture
KW - ultrasound
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U2 - 10.1016/j.ajem.2004.08.015
DO - 10.1016/j.ajem.2004.08.015
M3 - Article
C2 - 15666270
AN - SCOPUS:12444325196
SN - 0735-6757
VL - 22
SP - 601
EP - 604
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 7
ER -