title: The diagnostic efficacy of computed tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy.
abstract: BACKGROUND
  This study was designed to investigate the diagnostic efficacy of computed tomography (CT) for the detection diaphragmatic injury in cases undergoing diagnostic and therapeutic laparoscopy in left thoracoabdominal penetrating injuries.
  
  
  METHODS
  Demographic properties, stabbed body region, additional injuries, hemodynamic parameters, time to admission, diagnostic examinations, and type of treatment were retrospectively reviewed in one hundred and eight patients presenting with left thoracoabdominal injury after penetrating sharp object injury between April 2010 and December 2014. Preoperative CT scans of all patients were reviewed blind to the results of surgical evaluation. The relationship between diaphragmatic injury and hemothorax, pneumothorax, abdominal free fluid, and solid organ injuries were analyzed. All patients underwent physical examination, complete blood count monitoring, and hemodynamic assessment prior to surgery.
  
  
  RESULTS
  The most common finding on physical examination was anterior left thoracoabdominal injury. The injury was detected surgically in 36% of twenty-five cases with lateral injury. Diaphragmatic injury was present in twenty-five (23.1%) of all cases, all of whom were treated with laparoscopic repair. An analysis of all CT findings in relation to surgical results revealed that CT had a sensitivity of 80%, a specificity of 95%, a PPV of 83%, and a NPV of 94% for the detection of diaphragmatic injuries. Mean duration of hospital stay was 5.4 days (range, 1-16 days) in the entire study population.
  
  
  CONCLUSIONS
  CT is still associated with diagnostic challenges in penetrating diaphragmatic injuries. Nevertheless, CT showed a high specificity and a negative predictive value in our study. Detection of a diaphragmatic defect and fatty tissue herniation makes the definitive diagnosis of diaphragmatic injury in penetrating thoracoabdominal injuries. Prospective studies with a larger sample size are necessary to further clarify the role of CT in detection of diaphragmatic injuries in thoracoabdominal sharp penetrating object injuries.
authors.affiliation: Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey. op.dr.mehmetilhan@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: İlhan
authors.affiliation: Department of Radiology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: Mesut
authors.initials: M
authors.lastname: Bulakçı
authors.affiliation: Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Bademler
authors.affiliation: Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: Ali Fuat Kaan
authors.initials: AF
authors.lastname: Gök
authors.affiliation: Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: İbrahim Fethi
authors.initials: İF
authors.lastname: Azamat
authors.affiliation: Department of General Surgery, Trauma and Emergency Surgery Service, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Ertekin
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002648:Child; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult