HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pradip Sarkar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Khalil, M. W. Articles by Sarkar, P. Search for Related Content PubMed Articles by Khalil, M. W. Articles by Sarkar, P. Related Collections Diaphragm

Letters to the Editor

Re: Traumatic diaphragmatic rupture: look to see

^a Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, United Kingdom
^b Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, United Kingdom

Received 13 July 2008; accepted 18 August 2008.

^_* Corresponding author. Tel.: +44 114 2715526; fax: +44 114 2610350. (Email: wesam{at}doctor.com).

Key Words: Trauma • Right • Diaphragm

We read with interest the article by Turhan et al. about traumatic diaphragmatic rupture, especially their experience with right-sided ruptures [1]. We did report a case of late presentation of traumatic rupture of the right hemidiaphragm, which is more difficult to detect than left-sided injuries [2]. We cannot but fully agree with their conclusion that a high index of suspicion is of utmost importance for the diagnosis of this condition in any patient with thoracoabdominal injury. However, we would like to emphasise that this is even moreso in suspected right-sided injuries, when early diagnosis is difficult. The chest X-ray could be normal or show only slight elevation of the right hemidiaphragm, as was in our case. Magnetic resonance imaging has been shown to be very useful in establishing the diagnosis because of its capability of directly acquiring coronal and sagittal images allowing evaluation of the entire diaphragm. The disadvantage is that it cannot be easily carried out in an emergency situation, when helical CT remains the modality of choice [3].

We would also like to add that the same high index of suspicion should be held when dealing with post trauma patients who complain of persistent right-sided chest discomfort for many weeks post trauma. Diagnosis can remain elusive. In fact, in our case where the discomfort persisted for up to twenty-one weeks post trauma, even helical CT scan was only suggestive and confirmation was only achieved at operation, at which the diaphragmatic tear was repaired via the transthoracic approach. A persistently elevated right hemidiaphragm on routine radiography must arouse suspicion and lead to more investigations to rule out the condition.

References

1. Turhan K, Makay O, Cakan A, Samancilar O, Firat O, Icoz G, Cagirici U. Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 2008;33:1082-1085.[Abstract/Free Full Text]
2. Khalil MW, Sarkar PK. Late presentation of traumatic rupture of the right hemidiaphragm. Br J Hosp Med (Lond) 2005;66(8):482-483.[Medline]
3. Dosios T, Papachristos IC, Chrysicopoulos H. Magnetic resonance imaging of blunt traumatic rupture of the right hemidiaphragm. Eur J Cardiothorac Surg 1993;7(10):553-554.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pradip Sarkar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Khalil, M. W. Articles by Sarkar, P. Search for Related Content PubMed Articles by Khalil, M. W. Articles by Sarkar, P. Related Collections Diaphragm