scholarly journals Traumatic diaphragmatic rupture: a diagnostic challenge in the emergency department

2009 ◽  
Vol 2009 (jan08 1) ◽  
pp. bcr2006040451-bcr2006040451
Author(s):  
W-J Lee ◽  
Y-S Lee
Keyword(s):  
Emergency Department ◽  
Diaphragmatic Rupture ◽  
Diagnostic Challenge ◽  
Traumatic Diaphragmatic Rupture

scholarly journals Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Iclal Ocak ◽  
Diane C. Strollo
Keyword(s):  
Multidetector Ct ◽  
Diaphragmatic Injury ◽  
Diaphragmatic Rupture ◽  
Rib Fracture ◽  
Diagnostic Challenge ◽  
Traumatic Diaphragmatic Rupture ◽  
Polytrauma Patients ◽  
Fractured Ribs ◽  
Omental Fat

Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. In recent years, multidetector CT has markedly improved the diagnosis of diaphragmatic injury in polytrauma patients. Herein, we describe two cases of subacute presentation of traumatic diaphragmatic rupture from a penetrating rib fracture and subsequent intrathoracic herniation of omental fat, representing the CT “funky fat” sign.

Delayed presentation of traumatic diaphragmatic rupture with tension colothorax and strangulation of the transverse colon

2020 ◽  
Vol 13 (5) ◽  
pp. e233336
Author(s):  
Wassim Mousa ◽  
Christo Lapa ◽  
Cathleen Grossart ◽  
Asif Haq
Keyword(s):  
Emergency Department ◽  
Transverse Colon ◽  
Intensive Therapy ◽  
Rare Condition ◽  
Diaphragmatic Rupture ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
Chest Drain ◽  
Delayed Presentation ◽  
Traumatic Diaphragmatic Rupture

A 26-year-old man presented to emergency department with respiratory distress. The initial diagnosis after chest X-ray was massive haemothorax, after insertion of a chest drain and further investigations, it turned up to be a rare case of a delay presentation of traumatic diaphragmatic rupture (DR) (after 1 year of the initial trauma). After excessive resuscitation of the patient in the emergency department, the patient underwent an emergency laparotomy which revealed ischaemic transverse colon herniated into the chest through a 7 cm diaphragmatic defect. Resection of the ischaemic bowel had been done, and the patient admitted to Intensive Therapy Unit (ITU) postoperatively. The patient had an uneventful recovery and discharged home on postoperative day 9. As DR after thoracoabdominal trauma is a rare condition that can be missed at initial presentation, we would like to highlight the main challenges in diagnosing and managing similar cases after reviewing related cases in the literature.

Traumatic diaphragmatic rupture: delayed presentation following a SCUBA dive

2020 ◽  
Vol 13 (9) ◽  
pp. e234040
Author(s):  
Pei Yinn Toh ◽  
Simon Parys ◽  
Yuki Watanabe
Keyword(s):  
Abdominal Pain ◽  
Chest Pain ◽  
Laparoscopic Repair ◽  
Diaphragmatic Rupture ◽  
Delayed Presentation ◽  
Diagnostic Challenge ◽  
Traumatic Diaphragmatic Rupture ◽  
Breathing Apparatus ◽  
Life Threatening ◽  
Upper Abdominal

Traumatic diaphragmatic rupture (TDR) is a rare yet life-threatening occurrence that remains a diagnostic challenge for clinicians. Delayed presentation with associated strangulation of the contents, although uncommon, requires emergent management. A 42-year-old woman presented with constant, severe left-sided shoulder and chest pain, as well as associated upper abdominal pain following a self-contained underwater breathing apparatus (SCUBA) dive. A chest radiograph (CXR) and CT showed a left-sided diaphragmatic hernia containing stomach. She subsequently underwent a laparoscopic repair of the diaphragmatic defect and recovered well postoperatively.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals Emergency Department and Radiological Cost of Delayed Diagnosis of Cannabinoid Hyperemesis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
David I. Zimmer ◽  
Ross McCauley ◽  
Varun Konanki ◽  
Joseph Dynako ◽  
Nuha Zackariya ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
The United States ◽  
Clinical Syndrome ◽  
Cannabis Use ◽  
Diagnostic Challenge ◽  
High Clinical Suspicion ◽  
Ed Visits ◽  
Inappropriate Utilization ◽  
Utilization Of Healthcare

Background. Chronic cannabis use has become prevalent with decriminalization, medical prescription, and recreational legalization in numerous US states. With this increasing incidence of chronic cannabis use a new clinical syndrome has become apparent in emergency departments and hospitals across the country, termed Cannabinoid Hyperemesis (CH). CH has been described as cyclical vomiting and abdominal pain in the setting of chronic cannabis use, which is often temporarily relieved by hot showers. CH presents a diagnostic challenge to clinicians who do not have a high clinical suspicion for the syndrome and can result in high costs and resource utilization for hospitals and patients. This study investigates the expenditures associated with delayed CH evaluation and delayed diagnosis. Methods. This is a retrospective observational study of 17 patients diagnosed with CH at three medical centers in the United States from 2010 to 2015, consisting of two academic centers and a community hospital. Emergency department (ED) costs were calculated and analyzed for patients eventually diagnosed with CH. Results. For the 17 patients treated, the total cost for combined ED visits and radiologic evaluations was an average of $76,920.92 per patient. On average these patients had 17.9 ED visits before the diagnosis of CH was made. Conclusion. CH provides a diagnostic challenge to clinicians without a high suspicion of the syndrome and may become increasingly prevalent with current trends toward cannabis legalization. The diagnosis of CH can be made primarily through a thorough history and physical examination. Awareness of this syndrome can save institutions money, prevent inappropriate utilization of healthcare resources, and save patients from unnecessary diagnostic tests.

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