PubMed · 5762064
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C J Reynes, L Love. 1969. Mediastinal pseudocyst.. https://doi.org/10.1148/92.1.115
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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.
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The role of laparoscopy in the stepped approach to the diagnosis and treatment of blunt abdominal trauma has not yet been fully elucidated. Despite the use of a variety of imaging modalities, it can still be difficult to make a proper evaluation in cases where there are questionable abdominal injuries. In particular, when there is a discrepancy between a bland clinical picture and the results of diagnostic imaging procedures, laparoscopy should be given preference over laparotomy, provided the patient's circulatory situation is stable. Herein we describe a case in which laparoscopy allowed the detection and treatment of a traumatic rupture of a dysontogenetic splenic cyst that had mimicked a rupture of the spleen on both the ultrasound (US) and computed tomography (CT) images.