PROSPECTIVE EVALUATION OF THORACOSCOPY FOR DIAGNOSING DIAPHRAGMATIC INJURY IN THORACOABDOMINAL TRAUMA - A PRELIMINARY-REPORT

Diagnosis of diaphragmatic injury (DI) can be difficult in patients wi th penetrating trauma because physical examination, computed tomograph ic scan, chest x-ray films, and diagnostic peritoneal lavage may miss these injuries. Mandatory exploration has been recommended because of the increased mortality associated with missed DI. Thoracoscopy was pr ospectively evaluated as a less invasive method for diagnosing DI in p atients with penetrating trauma. Over a 14-month period, 14 patients w ere evaluated by thoracoscopy; video thoracoscopy was used in the last 9. Findings of thoracoscopy were confirmed by laparotomy or laparosco py. Thoracoscopy correctly identified the presence or absence of DI in nine and five patients, respectively (all patients). Video thoracosco py was easier and faster to perform than non-video thoracoscopy. This is the first reported series in which video thoracoscopy has been used for trauma. We found this procedure to be safe, accurate, and less in vasive than laparotomy for diagnosing DI.