Diaphragmatic rupture is a separation of the diaphragm from the thoracic wall, or a rent in the diaphragm itself. This is often traumatic, and disrupts the barrier between the thorax and the abdomen.
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Terminology
Traumatic diaphragmatic hernia is used to describe the condition after a traumatic rupture. Acquired diaphragmatic hernia is an additional term that clarifies the etiology. Diaphragmatic hernia is sometimes used, but has overlap with congenital forms of herniation.
Epidemiology
Traumatic diaphragmatic hernia is theorized that the increased pressure of trauma to the thorax while the larynx is closed causes the rupture. In dogs and cats, being hit by a car or other vehicle, dog fights, and high rise syndrome are common histories.
Clinical presentation
Traumatic diaphragmatic hernia may be asymptomatic or result in dyspnea. The presentation may be acute or chronic, especially in asymptomatic cases.
Pathology
Organs such as the liver, spleen, stomach, omentum, and small intestine may herniate into the thoracic cavity. A hernia is often accompanied by varying amounts of pleural effusion (transudate, hemorrhage). The space occupying mass of organ and effusion causes dyspnea, along with the decreased efficacy of the diaphragm in producing negative pressure for inspiration.
Radiographic features
Radiographic features include;
loss of visualization of the diaphragm on radiographs
pleural effusion
mediastinal shift away from the side of herniation
visible abdominal organs in the thorax
lack of visible organs in the abdomen
empty appearance to the abdomen with concave shape
Radiology report
The radiology report should include the description of abnormalities, extent, and severity.
Morphology
The side of the diaphragm and thorax affected
Degree of pleural effusion
Degree of mediastinal shift
Relationship to/involvement of
The organs suspected or certain to be herniated into the thorax
Abnormal enlargement of organs to indicate strangulation or obstruction
Treatment and prognosis
Surgical repair is indicated for replacement of the abdominal organs into the abdominal cavity and repair of the rupture. Better outcomes are expected from acute repair compared to chronic cases.
Complications
Complications can include respiratory compromise from the mass effect in the thorax, and strangulation of the gastrointestinal tract. This can result in distension of the stomach and small intestine as well as vascular compromise.
Postoperative complications can include pneumothorax, reexpansion pulmonary edema, hemorrhage, aspiration pneumonia, sepsis, and death.
Differential diagnosis
Differential diagnosis is seldom required except for in small ruptures.
pulmonary mass next to the diaphragm
unilateral pleural effusion
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