• Journal of Trauma and Injury
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• v.32 no.1
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• pp.66-70
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• 2019

Traumatic diaphragmatic injuries (TDIs) are a rare complication in thoraco-abdominal trauma. The diagnosis is difficult and if left untreated, TDI can cause traumatic diaphragmatic hernia (TDH). Through an injured diaphragm, the liver, spleen, stomach, small intestine, and large intestine can be herniated to the thoracic cavity, but pancreatic herniation and pancreatitis are quite rare in TDH. This paper reports a case of pancreatitis developed by additional trauma in a patient with asymptomatic chronic TDH. A 58-year-old male visited the emergency department with a left abdominal injury after a fall 6 hours earlier. The vital signs were stable, but the amylase and lipase levels were elevated to 558 U/L and 1,664 U/L, respectively. Abdominal computed tomography (CT) revealed a left diaphragmatic hernia and an incarceration of the stomach, pancreatic ductal dilatation, and peripancreatic fatty infiltration. Additional history taking showed that he had suffered a fall approximately 20 years ago and had an accidentally diaphragmatic hernia through a chest CT 6 months earlier. A comparison with the previous CT revealed the pancreatitis to be caused by secondary pancreatic ductal obstruction due to the incarcerated stomach. For pancreatitis, gastrointestinal decompression was performed, and after 3 days, the pancreatic enzyme was normalized; hence, a thoracotomy was performed. A small ruptured diaphragm was found and reposition of the organs was performed. This paper reports the experience of successfully treating pancreatitis and pancreatic hernia developed after trauma without complications through a thoracotomy following gastrointestinal decompression.

• Tuberculosis and Respiratory Diseases
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• v.87 no.1
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• pp.80-90
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• 2024

Background: There are many methods of evaluating diaphragmatic function, including trans-diaphragmatic pressure measurements, which are considered the key rule of diagnosis. We studied the clinical usefulness of chest ultrasonography in evaluating stable chronic obstructive pulmonary disease (COPD) patients and those in exacerbation, focusing on diaphragmatic measurements and their correlation with spirometry and other clinical parameters. Methods: In a prospective case-control study, we enrolled 100 COPD patients divided into 40 stable COPD patients and 60 patients with exacerbation. The analysis included 20 age-matched controls. In addition to the clinical assessment of the study population, radiological evaluation included chest radiographs and chest computed tomography. Transthoracic ultrasonography (TUS) was performed for all included subjects. Results: Multiple A lines (more than 3) were more frequent in COPD exacerbation than in stable patients, as was the case for B-lines. TUS significantly showed high specificity, negative predictive value, positive predictive value, and accuracy in detecting pleural effusion, consolidation, pneumothorax, and lung mass. Diaphragmatic measurements were significantly lower among stable COPD subjects than healthy controls. Diaphragmatic thickness and excursion displayed a significant negative correlation with body mass index and the dyspnea scale, and a positive correlation with spirometry measures. Patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D showed lower diaphragmatic measurements (thickness and excursion). Conclusion: The TUS of COPD patients both in stable and exacerbated conditions and the assessment of diaphragm excursion and thickness by TUS in COPD patients and their correlations to disease-related factors proved informative and paved the way for the better management of COPD patients.

• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.154-161
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• 1997

Purpose: Traumatic rupture of the diaphragm is not easy to diagnose and often delayed. Delayed diagnosis of diaphragmatic rupture accompanied by higher chances of strangulation of herniated viscera which may result in higher morbility and mortality. The purpose of this study was to evaluate diagnostic accuracy of spiral CT, MRI and US for the diagnosis of diaphragmatic rupture in an animal model. Materials and Methods: Small, medium, and large sized transabdominal diaphragmatic ruptures were surgically made in experimental rabbits and then followed up with spiral CT, MR!, and US at 1 day, 3 day, and 1 week after operation. Results: US was superior to MR! or spiral CT in diagnosis of diaphragmatic rupture(P(0.05). The sensitivity and specificity were 94.4% and 92.9% for US, 54.0% and 85.7% for MRI, and 46.0% and 78.6% for spiral CT, respectively. The size of laceration was not related to diagnostic sensitivity in US. Sensitivity of MRI and spiral CT increased as the size of laceration were larger, but no statistical significance was present(P>0.05). All experimental animals developed pleural effusion or hemothorax one day after operation. In acute phase, US and MRI were more sensitive than spiral CT in detecting diaphragmatic rupture. Spiral CT was more sensitive than US and MRI in delayed phase but without statistical significance(P>0.05). In the experimental rabbits with accompanying visceral hernia through the diaphragmatic defect, diagnostic accuracy was found equally high among three image modalities(P>0.05). Conclusion: This study indicates that US is the most accurate diagnostic method in detecting injury to the diaphragm in a rabbit model. The findings obtained in this experimental study can be applied to the diaphragmatic rupture of human being.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.328-335
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• 1976

This case report included 4 cases of traumatic diaphragmatic hernias, 3 cases of non-traumatic diaphragmatic hernias, and 3 cases of eventration of the diaphragm. Among the traumatic hernias, one case was in immediate phase of traumatic diaphragmatic rupture by traffic accident, 2 cases were in intermediate phase with chronic respiratory or vague gastrointestinal symptoms after traffic accident, and the other was developed after an operation, decortication for a chronic empyema with severe pleural calcifications, damaging the diaphragm. Three cases of nontraumatic diaphragmatic hernia were presented, including 2 cases of probable Bochadlek's hernia (Parents refused operation) and a case of Morgagni's hernia with severe gastrointestinal symptoms. And three cases of eventration of the diaphragm with symptoms were also reported. Results of all treated cases were excellent.

• Journal of Trauma and Injury
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• v.25 no.3
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• pp.87-90
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• 2012

Blunt diaphragmatic rupture (BDR) is a relatively rare injury and occurs in 0.8% to 7% of all thorocoabdominal blunt trauma. Especially right diaphragmatic rupture after blunt abdominal trauma is a rarer than left. The diagnosis of BDR can be missed while evaluating the multiple trauma patient. Other severe injuries may mask BDR during the primary resuscitation and survey. We experienced two cases of traumatic rupture of right diaphragm, one diagnosed immediately and the other diagnosed delayed. In this paper we present two cases of traumatic diaphragmatic rupture.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.471-478
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• 1988

We evaluated forty cases of traumatic diaphragmatic injuries that we have experienced from Jan. 1972 to Dec. 1987. 28 patients were male and 12 were female[M:F=2.3:1]. The age distribution was ranged from 4 to 71 years with mean age of 26. The diaphragmatic injuries were due to blunt trauma in 27 cases[traffic accident 22, fall down 3, others 2] and penetrating trauma in 13 cases[stab wound 11, gun shot 1, other 1]. In the blunt injury,14 cases of 17 were diagnosed and treated within 24 hours in the left diaphragmatic injury but only 3 cases of 7 cases in the right diaphragmatic injury were diagnosed and treated within 24 hours. All cases except one in penetrating injury were diagnosed and treated within 12 hours. In the blunt injury, the rupture site was located in the left in \ulcorner7 cases and in the right in 7 cases. In the penetrating injury, the rupture site was located in the left in 11 cases and in the right in 2 cases. The repair of 37 cases were performed with thoracic approach in 20 cases, thoracoabdominal approach in 12 cases and abdominal approach in 5 cases. Over all mortality was 17.5%[7/40] and postoperative mortality was 11%[4/37]. The causes of death were hypovolemic shock[3], combined head injury[2], acute renal failure[1] and septic shock with ARDS[1].

• Journal of radiological science and technology
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• v.24 no.2
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• pp.41-47
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• 2001

This study was undertaken to examine the differences between normal vocal technique and abnormal vocal technique because of diseases in respiratory system(emphysema). The breath control for vocalizing with diaphragmatic respiration must be sustained clearly. But if there is an abnormality in lung(emphysema), it is not sustained to hold diaphragmatic respiration when we sing. In order to examine the differences of the width in diaphragmatic respiration among professional singer's case, non professional case and the case of respiratory disturbance, Shimadzu X-ray remote control TV system was used. The results obtained were summerized as follows: When we vocalize, breath control is very important not only to sustain a resonance but also to form focus for being scattered to cranial resonance. We must know the differences between normal and abnormal diaphrogmatic respiration in order to teach vocal technique right. professional singer's vocal technique with Piaphragmatic respiration was better than that compared with non professional case and respiratory disturbance. Non professional case was very similar to the case of respiratory disturvance in diaphragmatic respiration until 10 sec. after full inhalation, but diaphragmatic respiration in the case of 20 sec. after full inhalation was very different.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.630-634
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• 1987

Anomalies of the diaphragm, particularly eventration, are not encountered frequently in clinical practices. Diaphragmatic eventration is generally accepted as an anomaly high position of part or all of the diaphragm, usually associated with a marked decrease in muscle fibers and a membranous appearance of the abnormal area. We experienced 3 cases of the congenital diaphragmatic eventration at the department of the thoracic and cardiovascular surgery, Maryknoll Hospital, which were treated successfully.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.851-854
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• 1987

Congenital diaphragmatic hernia remains a disease with high neonatal mortality rate despite recent advance in neonatal intensive care. We experienced one case of the congenital diaphragmatic hernia with acute respiratory distress and left pulmonary hypoplasia in the neonate. The simple closure was performed through left paramedian approach after diagnosis. The postoperative course was uneventful except wound disruption. The patient was follow-up with good general condition.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.180-183
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• 2016

A diaphragmatic injury is uncommon, but occurs more frequently with injury to other organs. Particularly, a diaphragmatic accompanied by a pericardial injury is very rare. The authors report a case of incidentally detecting a pericardial injury during surgery for a diaphragmatic injury due to abdominal blunt trauma.