title: Plain chest radiographs for the diagnosis of post-traumatic diaphragmatic hernia.
abstract: OBJECTIVE
  To describe changes in the radiographic examination of the chest in patients with post-traumatic diaphragmatic hernia (PTDH) confirmed intra-operatively.
  
  
  METHODS
  Between January 1990 and August 2008 45 patients with PTDH were treated. We analyzed demographic data, cause of injury, changes in chest radiography (CXR), extent and location of the diaphragmatic lesion and herniated organs. We described the radiographic findings most frequently identified by surgeons and radiologists.
  
  
  RESULTS
  CXR was performed on 32 patients, predominantly male (27 cases, 84.4%) and the mean age was 34 years. The most common cause of injury was blunt trauma (25 cases, 78.1%). Radiographic examination of the chest showed changes suggestive of PTDH in 26 cases (81.3%). During exploratory laparotomy, left PTDH was found in 28 cases (87.5%) and right in four (12.5%). The most frequently herniated organ was the stomach.
  
  
  CONCLUSIONS
  The study showed that CXR is very useful in the initial diagnostic approach to PTDH. The difficulty is that diaphragmatic injuries, particularly after penetrating trauma, may initially go unnoticed, and without changes in the CXR images, diagnosis is made difficult.
authors.affiliation: Faculdade de Ciências Médicas, Universidade Estadual de Campinas. elciohirano@ig.com.br
authors.forename: Elcio Shiyoiti
authors.initials: ES
authors.lastname: Hirano
authors.forename: Vanessa Gonçalves
authors.initials: VG
authors.lastname: Silva
authors.forename: José Benedito
authors.initials: JB
authors.lastname: Bortoto
authors.forename: Ricardo Hoelz de Oliveira
authors.initials: RH
authors.lastname: Barros
authors.forename: Nelson Marcio Gomes
authors.initials: NM
authors.lastname: Caserta
authors.forename: Gustavo Pereira
authors.initials: GP
authors.lastname: Fraga
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods; D055815:Young Adult