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Eur J Cardiothorac Surg 2008;34:1127. doi:10.1016/j.ejcts.2008.08.010
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Reply to Khalil and Sarkar

Kutsal Turhana,*, Ozer Makayb, Ozgur Firatb, Ozgur Samancilara

a Ege University, Faculty of Medicine, Department of Thoracic Surgery, Izmir, Turkey
b Ege University, Faculty of Medicine, Department of General Surgery, Izmir, Turkey

Received 12 August 2008; accepted 18 August 2008.

* Corresponding author. Tel.: +90 232 3904919; fax: +90 232 3904681. (Email: kutsal.turhan{at}ege.edu.tr).

Key Words: Thoracoabdominal trauma • Diaphragmatic injury • Diagnosis

We appreciate the comments of Khalil and Sarkar [1] that they made concerning our paper about traumatic diaphragmatic rupture [2]. We also appreciate the fact that they mentioned the difficulties in the early diagnosis of right-sided diaphragmatic injuries. Meanwhile, we did not understand why they do not agree with our conclusion that a high index of suspicion is of utmost importance for the diagnosis of these patients, since they mentioned that a persistently elevated right hemidiaphragm on routine X-ray must arouse suspicion. Clearly, we reported 11 patients with right-sided injury where 2 of them had late diagnosis. Although the major complaint of these two patients was dyspnea, we agree with Khalil and Sarkar that a high index of suspicion should also be held when dealing with post-trauma patients who complain of persistent right-sided chest discomfort after trauma.

Furthermore, in our paper, we emphasized the sensitivities of radiological investigations, where a chest X-ray reached 17% sensitivity, while this rose to 50% with a CT in right-sided injuries. In other words, chest X-ray can be normal in such cases. Certainly, diagnosis can be elusive, as we stated. There are reviews questioning the role of each imaging method [3]. Shanmuganathan et al. highlighted that if the chest radiography is indeterminate, spiral computed tomography with thin sections and reformatted images is the next study of choice and magnetic resonance imaging is only used to evaluate the diaphragm for patients with clinical suspicion but an indeterminate diagnosis after chest radiography and spiral CT [4].

Herein, it is stated that detection of diaphragmatic injuries has improved with helical CT and should further improve with multisection CT for more accurate analysis of the diaphragm.

References

  1. Khalil MW, Sarkar PK. Re: Traumatic diaphragmatic rupture: look to see. Eur J Cardiothorac Surg 2008;34:1127.[Free Full Text]
  2. 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]
  3. Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG. Imaging of diaphragmatic injury: a diagnostic challenge?. Radiographics 2002;22:103-118.
  4. Shanmuganathan K, Killeen K, Mirvis SE, White CS. Imaging of diaphragmatic injuries. J Thorac Imaging 2000;15:104-111.[CrossRef][Medline]



This article has been cited by other articles:


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Reply to Khalil and Sarkar
Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 1127 - 1127.
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This Article
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