Traumatic diaphragmatic injuries in infants and children: imaging findings

Objectives. Traumatic diaphragmatic injuries (DI) in infants and children a re uncommon and are often associated with multiple severe injuries. Delayed presentation can be life threatening due to organ herniation and strangula tion. We present the imaging findings in a relatively large population of c hildren who experienced this rare injury. Methods. Medical records of all patients admitted to our Trauma Service fro m 1977 to 1998 with DI were retrospectively reviewed recording imaging, cli nical and surgical or autopsy findings. Results. Of sixteen patients with DI (7 females, 9 males; age 3 weeks to 15 years), 14 suffered from blunt trauma secondary to high-energy impact, and 2 from penetrating injuries. Unilateral DI occurred equally on each side, with one bilateral injury. Associated injuries, present in 81%, included se vere head injuries, visceral, mesenteric and vascular injuries and multiple fractures. Six patients died from multiple organ failure (3), head injury (2), and shock (1). Findings in the initial chest X-ray suggested the diagn osis in 13 (81%) of 16 injuries, and CT demonstrated irregularity and thick ening of the diaphragm in 4 out of 7. Conclusions. Plain film findings suggested the diagnosis in most; CT and MR were useful adjuncts. High index of suspicion and awareness of the mechani sm of injury can lead to prompt diagnosis, early repair, and decreased morb idity and mortality.