Department of Radiology, Vancouver General Hospital/University of British Colombia, Vancouver, British Colombia, Canada.
Faculty of Medicine, University of British Colombia, Vancouver, British Colombia, Canada.
Can Assoc Radiol J. 2020 Aug;71(3):313-321. doi: 10.1177/0846537120905133. Epub 2020 Mar 11.
Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries.
创伤性横膈膜损伤（TDI）是一种诊断不足的病症，由于与汽车碰撞有关，其患病率最近有所增加。初始损伤常常被并发的胸部和腹部损伤所掩盖。创伤性横膈膜损伤本身在初次出现时很少致命，然而，未经治疗的 TDI 相关的损伤和并发症，如内脏疝出和绞窄，会产生严重的临床后果。TDI 有 2 种主要机制：穿透性 TDI 往往较小，更难发现，并发症也较少；钝性 TDI 较大，由于相关损伤或延迟并发症，总体死亡率更高。胸腔和腹腔的解剖结构区分了右侧和左侧 TDI 的流行病学、病理生理学、症状、治疗和预后。虽然没有明确的影像学征象来诊断 TDI，但文献中已经介绍了许多征象，并且多个征象的同时存在增加了 TDI 检测的敏感性。保守治疗与手术治疗取决于 TDI 的机制、损伤侧以及最重要的是相关损伤。
