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Diaphragmatic rupture
Other names	Diaphragmatic injury, diaphragmatic tear
An X-ray showing a raised diaphragm on the right due to a rupture of the diaphragm on that side. [1]
Specialty	Cardiothoracic surgery
Symptoms	Difficulty breathing, chest pain [2]
Complications	Diaphragmatic herniation [2]
Causes	Physical trauma [3]
Diagnostic method	Medical imaging, exploratory surgery [3]
Differential diagnosis	Pneumothorax, abdominal free air [3]
Treatment	Surgery, nasogastric tube [3]
Frequency	Uncommon [3]
Deaths	4 to 15% risk of death [2]

Diaphragmatic rupture, also known as diaphragmatic injury, is a tear of the diaphragm, the muscle across the bottom of the ribcage, which is involved in breathing. ^[4] Symptoms include chest and abdominal pain, difficulty breathing, and decreased lung sounds. ^{[2] [3]} Complications may include diaphragmatic herniation of abdominal contents, after which bowel strangulation may occur. ^[2]

Most commonly, acquired ruptures result from physical trauma. ^[3] It can result from penetrating injury (60%) such as stabbings or blunt injury (40%) such as motor vehicle collisions. ^[2] In about 80% of cases the left side is involved. ^[2] Diagnostic techniques may include X-ray, computed tomography, or exploratory surgery. ^[3] However; signs may not show on X-ray or CT scan or appear similar to other conditions. ^[3]

When a tear is discovered, surgery is generally needed to repair it. ^[3] This includes in cases that may have originally been missed. ^[2] The injury may be approached via the abdomen or the chest depending on the presumed associated injuries. ^[2] A nasogastric tube may be placed to decompress the stomach. ^[3] There are often other injuries and outcome depends more on associated injuries than on the diaphragmatic injury itself. ^[2]

Diaphragmatic rupture is uncommon. ^[3] In people who have experienced trauma, it occurs in under 1%. ^{[3] [2]} Males are more commonly affected than females. ^[3] The risk of death is 4% for cases involving a penetrating injury and 15% for blunt injury. ^[2] The condition has been described since at least the 16th century by Ambroise Paré. ^{[5] [4]}

References