Early recognition of diaphragmatic injuries from blunt trauma.

Rupture of the diaphragm from blunt trauma was identified in 42 patients in four years. The contribution of peritoneal lavage in identifying these injuries was examined. More than 93% of the ruptured diaphragms were identified within 24 hours. Peritoneal lavage was positive in 89% of patients who had no other source of intraabdominal hemorrhage. Chest radiography alone identified 41% of the patients who had diaphragm injury. If the peritoneal lavage is negative and the best radiograph is not diagnostic but suspicion of diaphragm injury remains, the lavage catheter can still be used to instill contrast into the peritoneum. Peritoneal lavage, when used in combination with chest radiography, is a reliable, rapid, and simple aid in identifying ruptured diaphragms from blunt trauma.