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Diaphragmatic Laceration After Penetrating Trauma

upture of the diaphragm usually occurs from blunt or penetrating trauma to the abdomen or chest and is found in up to 5% of patients with trauma. 1,2 In the acute setting, the diagnosis is often missed because of nonspecific R clinical and radiographic signs and symptoms. 1-3 Problems often arise later in the clinical course because of the inability of the diaphragm to heal spontaneously and subsequent bowel or organ herniation through a persistent defect. 4 - 6 In addition to radiography and computed tomography (CT), focused assessment with sonography for trauma (FAST) is another imaging modality now routinely used in many acute care trauma centers. 7-9 One of the staples of FAST is the detection of free pericardial or intra-abdominal fluid in the unstable patient. 7-9 More recently, an extension of the FAST examination to include evaluation for acute hemothorax and pneumothorax (extended focused assessment with sonography for trauma [E-FAST]) has been proposed, which also comprises imaging of the diaphragm. 10 Several investigations showed high accuracy of bedside sonography for these common pulmonary injuries, but surprisingly there are only a few publications showing the utility of FAST or E-FAST for detecting diaphragmatic trauma. 11-17 We present a case of a diaphragmatic laceration from an abdominal stab wound diagnosed with E-FAST. The direct and indirect sonographic findings of this phrenic injury and potential utility of this technique in acute trauma imaging are discussed.