title: Evaluation of intrapleural contrast-enhanced abdominal pelvic CT-scan in detecting diaphragm injury in stable patients with thoraco-abdominal stab wound: a preliminary study.
abstract: BACKGROUND
  Many of the patients with thoraco-abdominal stab wound remain asymptomatic; in this regard, previous studies reported that 7-48% of asymptomatic patients had diaphragm injury (DI). Thoracoscopy or multidetector computed tomography (MDCT) scan is the best method to detect DI. We aimed to evaluate the role of CT scan with intrapleural contrast to rule out DI in stable thoraco-abdominal stab wounds.
  
  
  METHODS
  In a prospective study, we evaluated all haemodynamically stable patients with thoraco-abdominal stab wound, from October 2009 to 2010. Exclusion criteria included patients who needed emergency thoracotomy or laparotomy, those who were haemodynamically unstable and those with blunt trauma or gunshot injury. In the CT-scan department, 500 cc of diluted meglumine diatrozate was transfused into the pleural space via a chest tube and the CT scan was performed from the dome of the diaphragm to the pelvic cavity. In the second step, all patients were taken for thoracoscopy within 24h after admission. The CT-scan slide was considered positive if one of the following signs was found: (1) the diaphragm was obviously injured as seen in CT-scan slides and (2) contrast agent was seen in the peritoneal cavity. Sensitivity and specificity were calculated for CT scan and thoracoscopy.
  
  
  RESULTS
  Four out of 40 patients had DI according to thoracoscopy. CT scan with intrapleural contrast predicted diaphragmatic injury correctly in all four patients. Considering thoracoscopy as the gold-standard method, the CT scan had two false-positive cases. The sensitivity of the intrapleural-contrast CT scan was 100% and its specificity was 94.4%.
  
  
  CONCLUSIONS
  Our study showed that CT scan with intrapleural contrast can be an acceptable approach to rule out DI and limit the use of thoracoscopy for final diagnosis and repair of DI in cases with suspicious or positive CT-scan results, especially in trauma centres with high load of trauma patients and little accessible equipment.
authors: Shiraz University of Medical Sciences - Trauma Research Center, Iran.
authors: Hamid Reza
authors: HR
authors: Abbasy
authors: Farzad
authors: F
authors: Panahi
authors: Sepideh
authors: S
authors: Sefidbakht
authors: Majid
authors: M
authors: Akrami
authors: Shahram
authors: S
authors: Paydar
authors: Sedighe
authors: S
authors: Mirhashemi
authors: Shahram
authors: S
authors: Bolandparvaz
authors: Kambiz
authors: K
authors: Asaadi
authors: Roohollah
authors: R
authors: Salahi
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000293:injuries*; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed / Q000379:methods; D014951:Wounds, Stab / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine