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Keyes S, Spouge RJ, Kennedy P, Rai S, Abdellatif W, Sugrue G, Barrett SA, Khosa F, Nicolaou S, Murray N. Approach to Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities. Radiographics 2024; 44:e230110. [PMID: 38781091 DOI: 10.1148/rg.230110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sarah Keyes
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Rebecca J Spouge
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Padraic Kennedy
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Shamir Rai
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Waleed Abdellatif
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Gavin Sugrue
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Sarah A Barrett
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Faisal Khosa
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Savvas Nicolaou
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Nicolas Murray
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
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Soares T, Oliveira MA, Panisset K, Habib N, Rahman S, Klebanoff JS, Moawad GN. Diaphragmatic endometriosis and thoracic endometriosis syndrome: a review on diagnosis and treatment. Horm Mol Biol Clin Investig 2021; 43:137-143. [PMID: 34704688 DOI: 10.1515/hmbci-2020-0066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis of the diaphragm has been gaining more attention in the practice of gynecologists and thoracic surgeons in recent years. Understanding related symptoms and developing imaging methods have improved their approach. A review of the literature was performed with the aim to report on incidence, diagnosis, treatment and prognosis of diaphragmatic endometriosis. We also cover the issue of the Thoracic Endometriosis Syndrome (TES). Complaints of cyclic chest pain in patients of childbearing age should have as differential diagnosis the presence of thoracic endometriosis. Catamenial pneumothorax is the main manifestation of diaphragmatic endometriosis and Thoracic Endometriosis Syndrome. Other possible manifestations are hemothorax, pulmonary nodules, and diaphragmatic hernia. Despite the possibility of drug treatment, many patients will be submitted to surgical treatment. The minimally invasive approach should be the one of choice. The robotic pathway allows for an easier approach due to its ability to articulate robotic arms, allowing the treatment of lesions in hard-to-reach locations, such as the posterior part of the diaphragm. Multidisciplinary treatment should be used in most cases, as only abdominal approach is not sufficient for the diagnosis and treatment of lesions in the thoracic cavity. The approach of endometriosis of the diaphragm and Thoracic Endometriosis Syndrome should be multidisciplinary, allowing the improvement of quality of life in most patients.
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Affiliation(s)
- Thiers Soares
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Cardoso Fontes Hospital, Gynecologic Section, Rio de Janeiro, Brazil.,Perinatal Hospital, Rio de Janeiro, Brazil.,Casa de Saúde São José, Rio de Janeiro, Brazil
| | - Marco Aurelio Oliveira
- Department of Obstetrics and Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karen Panisset
- Perinatal Hospital, Rio de Janeiro, Brazil.,Maternal and Child Department, Fluminense Federal University, Niteroi, Brazil
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Beaujon Hospital-University of Paris, Clichy Cedex, France
| | - Sara Rahman
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynnewood, PA, USA
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
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