PubMed · 2928022
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R Schlechter, A Besserman. 1989. Is Hypaque dangerous?. https://pubmed.ncbi.nlm.nih.gov/2928022/
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INTRODUCTION: The aim of this study was to describe our experiences with ultrasonography (US) of severely traumatised patients, and to show whether it is a safe and fast procedure when screening for intra-abdominal lesions. MATERIAL AND METHODS: In a period from 1996 to 1999, 876 patients were received by the trauma team. The number of patients with an injury severity score (ISS) > 15, was constant during the period. Seventy-five per cent of the patients were men. One hundred and fifty-five patients (18%) died, 111 before US was carried out. RESULTS: Over the four-year period, the number of patients received by the trauma team increased from 150 in 1996 to 365 in 1999. The number of US examinations increased from 61 (1996) till 303 (1999). The number of pathological US scans was constantly about 20 per year, where as the number of pathological CT scans was between ten and 20 per year. The number of patients that went on to explorative laparotomy was between seven and 17 per year and 49 in the whole period. The sensitivity of US to detect abdominal lesions is 0.74 and the specificity 0.97, whereas that to detect free abdominal fluid is 0.88 and the specificity 0.99. DISCUSSION: US of the abdomen is a fast and safe procedure to carry out on the severely traumatised patient. An algorithm for diagnosis is suggested.
BACKGROUND: Traumatic rupture of diaphragm is caused by blunt or penetrating trauma. Early diagnosis is difficult, and complications such as visceral herniation may arise. A 10-year evaluation of all diagnostic procedures used in patients with surgically proved traumatic rupture of the diaphragm is presented. METHODS: A review of all patients with surgically proved diaphragmatic injury from 1988 to 1998 was conducted. All diagnostic methods were analyzed in terms of their ability to identify diaphragmatic rupture. RESULTS: During the study period, 31 patients with a mean age of 34 years were treated. Of these patients, 20 sustained blunt trauma and 11 experienced penetrating trauma. The initial chest x-ray was diagnostic for 6 of the 31 patients, nonspecific for 15 of the patients, and normal for 10 of the patients. In no case was sonography diagnostic. Thoracoabdominal computed tomography (CT), performed in 22 of the patients, led to diagnosis for 5 patients and unspecific findings for 17 patients. Statistical analyses showed no significant difference between initial chest x-ray and thoracoabdominal CT. No significant difference between blunt or penetrating trauma or between left-side and right-side ruptures could be recognized with any diagnostic tool. CONCLUSIONS: All the diagnostic methods investigated in this study showed unsatisfying results, and traumatic rupture of the diaphragm seems to remain a diagnostic dilemma. Endoscopic techniques not tested in this study and discussed controversially may offer a good chance for early diagnosis and repair of the injured diaphragm.