Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report.

Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.

Laparoscopic Repair Following a Delayed Presentation of Traumatic Diaphragmatic Hernia: A Case Report.

Traumatic diaphragmatic hernia is a rare condition that occurs after trauma, and some patients have a delayed presentation. A laparoscopic approach is rarely used to repair traumatic diaphragmatic hernias. We encountered a case of asymptomatic diaphragmatic hernia diagnosed after a comprehensive medical examination. A 71-year-old woman was diagnosed with a delayed presentation of traumatic diaphragmatic hernia with prolapse of the greater omentum owing to a traffic injury 20 years ago. Surgery was performed laparoscopically using three ports, and intraoperative respiratory management was performed using a double-lumen tube. The 2.5-cm-diameter hernial orifice was sutured under contralateral one-lung ventilation after the greater omentum was returned to the abdominal cavity. The patient's postoperative course was uneventful, and she was discharged on the third day. Intraoperative strategies such as respiratory management and the laparoscopic approach play a crucial role in ensuring favorable postoperative outcomes. The last follow-up was at six months post-operation, and the patient was doing well.

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery.

BACKGROUND: Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. METHODS: We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. RESULTS: Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. CONCLUSIONS: We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

The Role of Minimally Invasive Surgeries in Trauma.

This article delves into the role of minimally invasive surgeries in trauma, specifically laparoscopy and video-assisted thoracic surgery (VATS). It discusses the benefits of laparoscopy over traditional laparotomy, including its accuracy in detecting peritoneal violation and intraperitoneal injuries caused by penetrating trauma. The article also explores the use of laparoscopy as an adjunct to nonoperative management of abdominal injuries and in cases of blunt trauma with unclear abdominal injuries. Furthermore, it highlights the benefits of VATS in diagnosing and treating thoracic injuries, such as traumatic diaphragmatic injuries, retained hematomas, and persistent pneumothorax.

Right Diaphragmatic Rupture: A Case Report of a Rare Surgical Trauma Emergency.

Diaphragmatic injuries, particularly on the right side, are a rare yet challenging clinical scenario, especially when associated with other injuries. We present the case of a 38-year-old male patient who sustained a fall from a significant height, resulting in blunt abdominal trauma, chest injuries, right-side diaphragmatic injury, a grade 4 liver injury, and fractures of the right ribs, right femur, and pelvis. The patient also suffered a lung laceration with hemopneumothorax. The clinical team managed these injuries through a video-assisted thoracoscopy, laparotomy, and primary repair of the diaphragmatic rupture. The postoperative course was complicated by a low-output bile leak and infection of the orthopedic surgical wound, but these were effectively managed, and the patient showed a steady recovery. This case underscores the complexity of managing traumatic injuries that span multiple body regions and systems, requiring a coordinated, multidisciplinary approach. It also highlights the critical role of timely intervention and appropriate surgical strategies in the successful recovery of patients from complex traumas.

Twenty-year perspective on blunt traumatic diaphragmatic injury in level 1 trauma centre: Early versus delayed diagnosis injury patterns and outcomes.

OBJECTIVE: Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. METHODS: A retrospective review was conducted of patients with blunt-TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non-survivor and survivor groups were collected to examine factors associated with delayed diagnosis. RESULTS: A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made <24 h in 126 (81.3%), and >24 h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed >7 days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty-eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural-effusions/elevated-hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. CONCLUSION: The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower-chest/upper-abdomen, a high degree of clinical suspicion should be held and follow-up CXRs/CTs arranged.

The edemiological state of blunt diaphragmatic injury: An analysis of a nationwide trauma registry in Japan.

BACKGROUND: Little is known about blunt traumatic diaphragmatic injury (BTDI). This study aimed to investigate the epidemiological state of BTDI, using a nationwide trauma registry in Japan. METHODS: Data of patients aged ≥18 years who experienced blunt injury between January 2004 and May 2019 were extracted from the Japan Trauma Data Bank. Demographics, cause of trauma, mechanism of injury, physiological parameters, organ injuries, and bone fractures were compared between patients with and those without BTDI. Multivariable logistic regression analysis was performed to identify factors associated with BTDI. RESULTS: A total of 305,141 patients from 244 hospitals were analyzed. The median patient age (interquartile range) was 65 (44-79) years, and 185,750 (60.9%) were men. BTDI was diagnosed in 868 patients (0.3%). The prevalence of BTDI was stable, between 0.2 and 0.6%, over the study period. Among the 868 patients with BTDI, 408 (47.0%) fatalities were recorded. Mortality rates in each year were 42.5-68.2%, with no significant trend toward an improved outcome (P = 0.925). Our multivariable logistic regression analysis found that mechanism of injury, Glasgow Coma Scale score (9-12 or 3-8) on hospital arrival, hypotension (systolic blood pressure <90 mmHg) on hospital arrival, organ injuries (lung, heart, spleen, bladder, kidney, pancreas, stomach, and liver), and bone fractures (rib, pelvis, lumbar spine, and upper extremities) were independently associated with BTDI. CONCLUSION: Using a nationwide trauma registry, this study revealed the epidemiological state of BTDI in Japan. BTDI was found to be a very rare but devastating injury, with high in-hospital mortality. Some clinical factors, such as mechanism of injury, Glasgow Coma Scale score, organ injuries, and bone fractures, were independently associated with BTDI.

Laparoscopic Repair of a Right-Sided Diaphragmatic Hernia: A Technical Report.

Introduction: Occult diaphragmatic hernias after trauma are relatively rare and may present months to years after the traumatic event. Clinical presentations range from asymptomatic incidental findings on imaging to life-threatening incarceration of abdominal visceral organs. This study presents a case of a patient with a symptomatic diaphragmatic hernia secondary to a trauma >30 years prior. A literature review of this defect was performed examining the pathophysiology, presentation, and operative considerations. Case Presentation: A 58-year-old male with a history of multiple traumatic motor vehicle accidents 30 years prior presented with abdominal pain and obstructive symptoms. Axial imaging demonstrated a right-sided diaphragmatic hernia defect containing small intestine, colon, and omentum. He ultimately underwent a transabdominal laparoscopic repair of the defect with mesh buttressing. Postoperative the patient recovered well and was discharged without complications. Conclusion: Limited data outside of case reports exist for surgical management of occult diaphragmatic hernias secondary to trauma. Reported management options include open and minimally invasive thoracic as well as open and minimally invasive abdominal approaches; each with advantages and disadvantages. Depending on the defect size, both primary repair and repair with mesh reinforcement are appropriate options. More data comparing the approach and repair technique are needed to determine the best technique.

Post-traumatic giant thrombosis of inferior vena cava induced right-sided blunt traumatic diaphragmatic injury: a case report.

BACKGROUND: Inferior vena cava thrombosis is a severe disease as it carries a higher risk of developing pulmonary embolism associated with a high mortality rate. The incidence of inferior vena cava thrombosis is extremely low and is commonly associated with outflow obstruction of the inferior vena cava. The frequency of traumatic diaphragmatic injuries is less than 1% of all traumatic injuries. In addition, it was not a typical cause of inferior vena cava obstruction. We report the case of the patient who presented with giant thrombosis of the inferior vena cava, which required surgical treatment-induced right-sided blunt traumatic diaphragmatic injury. CASE PRESENTATION: A 60-year-old male presented to the emergency department with pelvic and lower leg pain. He was working on a dump truck with the bed raised position. Suddenly, the bed came down, and his body was crushed and injured. Primary CT showed a right lung contusion and elevation of the right diaphragm but no apparent liver injury. The right pleural effusion gradually worsened after admission, as the traumatic diaphragmatic injury was highly suspected. Repeat CT showed aggravation of elevation of the right-sided diaphragm, narrowing of the inferior hepatic vena cava due to left cephalic deviation of the liver, and formation of a giant thrombus in the inferior vena cava. No adverse hemodynamic effects were observed due to thrombus formation, and we performed thrombolytic therapy. The day after starting thrombolytic therapy, the patient developed pulmonary embolism due to a dropped in SpO2 needed oxygen, and dyspnea triggered by coughing. Thrombolytic therapy was continued after the diagnosis of pulmonary embolism. However, thrombolytic therapy was ineffective, so we decided on surgical thrombectomy and inferior vena cava filter placement. The postoperative course was not eventful, and an anticoagulant was started. The patient was transferred to the hospital on the 62nd day for rehabilitation. CONCLUSIONS: When a diaphragmatic hernia is suspected of causing hepatic hernia and narrowing of the inferior vena cava, it may be necessary to consider emergency surgical treatment to prevent secondary inferior vena cava thrombosis and fatal pulmonary embolism.

Successful artificial pneumothorax thoracoscopic repair of a right-sided diaphragmatic injury with hemothorax. A case report.

INTRODUCTION AND IMPORTANCE: Right-sided blunt diaphragmatic injury (BDI) is rare and often missed initially. Recently, some studies reported increased use of minimally invasive repair. A case of unexplained hemothorax that led to early suspicion of right-sided BDI, which was confirmed by exploratory thoracoscopy with an artificial pneumothorax, and primary repair was completed, is presented. CASE PRESENTATION: A 47-year-old woman had a moderate right hemothorax without rib fracture, vertebral fracture, or lung injury. A chest tube was inserted for the hemothorax, and approximately 470 mL of blood were evacuated initially. The right-sided BDI was not initially identified. Diagnostic thoracoscopy with an artificial pneumothorax confirmed diaphragmatic laceration. The liver was pushed back into the abdominal cavity with the use of the artificial pneumothorax. Primary closure of the diaphragmatic laceration was performed. CLINICAL DISCUSSION: We must consider that a hemothorax without a lung injury or a chest wall injury may be a BDI. Thoracoscopy contributes to identifying and repairing a diaphragmatic injury. Additionally, an artificial pneumothorax provided a good operative field and spontaneously reduced the liver into the abdominal cavity, which facilitates the thoracoscopic repair of BDI. CONCLUSION: Unexplained hemothorax may be due to diaphragmatic injury, and exploratory thoracoscopy with an artificial pneumothorax may contribute to identifying and repairing a diaphragmatic injury.

Rib spur causing a hemothorax, pneumothorax, and diaphragmatic injury in a pediatric patient.

Pleural effusion is a relatively common condition encountered in the pediatric emergency department. Evaluation of pleural effusion in the emergency department typically includes advanced imaging such as computer tomography or ultrasound, as well as diagnostic thoracocentesis. We report a case of a 10-year-old female with a rib spur at the anterolateral left sixth rib that caused a hemothorax, pneumothorax, and diaphragmatic injury. The patient underwent video-assisted thoracoscopic surgery and resection of the rib spur. The procedure was well-tolerated without any complications.

Management of Traumatic Diaphragmatic Injury-A Peep into Bowel Repair via Thoracotomy.

Background: Traumatic diaphragmatic injury (TDI) is a relatively rare condition, and there is a high tendency for it to be missed if thorough clinical assessment and imaging review are not carried out. The surgical approach for TDI can be challenging, especially with bowel perforation. Materials and Methods: This is a retrospective case series of all consecutive patients with TDI from two tertiary hospitals in the southern part of Nigeria between January 2013 and December 2019. The demographic data of the patients, type, cause, and clinical diagnosis, intraoperative findings, Injury Severity Score, and outcome were noted. The descriptive statistics were presented in percentages and fractions. Results: Fourteen (4.3%) of the 326 chest trauma patients had TDI with 57.1% from penetrating causes and 42.9% from blunt causes. The causes of the TDI were gunshot injuries (42.9%), road traffic crashes (35.7%), stab injury (14.3%), and domestic accidents (7.1%). The preoperative method of diagnosis was mainly by massive haemothorax necessitating open thoracotomy (42.9%) and mixed clinical evaluation, chest radiograph, and upper gastrointestinal contrast studies (35.7%), and the drainage of intestinal content following the insertion of a chest tube to initially drain haemothorax (21.4%) and other modality of diagnoses (7.1%). The operative finding was mainly intestine content in the chest (50%) and only diaphragmatic injury (35.7%). The major complication after surgery was empyema thoracis (14.3%) and the mortality rate (14.3%). Conclusion: Penetrating injury of the chest was the major factor responsible for the TDI, and even with bowel perforation and acute TDI, thoracotomy offered an effective surgical approach for all the patients.

Risk factors for posttraumatic empyema in diaphragmatic injuries.

BACKGROUND: Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center. METHODS: This is a retrospective review of the patients who survived more than 48 h. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors. RESULTS: We included 192 patients treated from 2011 to 2020. There were 169 (88.0) males. The mean interquartile range, (IQR) of age, was 27 (22-35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18-44) and 17 (10-27), respectively. Thoracic AIS was > 3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%): stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%). Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with video-assisted thoracoscopy surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple logistic regression identified thoracic AIS > 3 (OR 6.4, 95% CI 1.77-23. 43), and visible contamination (OR 5.13, 95% IC 1.26-20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema. CONCLUSION: The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors for empyema after penetrating diaphragmatic trauma.

A rare case report of perforated viscerothorax in a traumatic diaphragmatic rupture.

INTRODUCTION: Diaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the presence of diaphragmatic herniations. Delayed presentation is associated with the influx of visceral contents into the thoracic cavity, which may cause strangulation and obstruction. Viscerothorax is a rare complication of diaphragmatic injuries. PRESENTATION OF CASE: A case report of a 25-year-old male patient with a history of penetrating chest injury. He presented to our setting with a sharp abdominal pain and episodes of vomiting that were later accompanied by chest pains and difficulty breathing. A CT scan revealed the presence of a left hemidiaphragmatic injury with a viscerothorax and mediastinal shift to the right side. Surgery was immediately done and with a good postoperative outcome. DISCUSSION: Diaphragmatic injuries are still uncommon and are often overlooked in initial presentations. The presence of herniation through the defect prompts early diagnosis. Delayed presentations of these injuries are often affiliated with herniations that may be strangulating or obstructing with more severe complications such as viscerothorax causing tension into the thoracic cavity. CONCLUSION: The approach to diaphragmatic injuries at their initial presentation must be handled with an excellent index of suspicion in the evaluation of trauma victims to reduce management delay and avoid detrimental complications in contrast to the involvement of other associated injuries such as haemothorax, rib fractures, and visceral injuries. Early defect diagnosis followed by definitive surgical repair is the most favoured approach.

Contralateral diaphragmatic injury sustained from transhumeral amputation: an unusual case and brief literature review.

Right-sided diaphragmatic injury is an uncommon sequelae from blunt trauma and may be associated with other severe thoracoabdominal injuries. This injury can be easily missed on initial assessment and a high index of suspicion and clinical judgment is required. Recently, we treated a 25-year-old male inflicted with a right-sided diaphragmatic injury after a left-sided transhumeral amputation sustained from an overturned motor vehicle collision with thoracoscopic exploration and reapproximation.

Traumatic diaphragmatic rupture: epidemiology, associated injuries, and outcome-an analysis based on the TraumaRegister DGU®.

INTRODUCTION: Traumatic diaphragmatic rupture is a rare injury in the severely injured patient and is most commonly caused by blunt mechanisms. However, penetrating mechanisms can also dominate depending on regional and local factors. Traumatic diaphragmatic rupture is difficult to diagnose and can be missed by primary diagnostic procedures in the resuscitation room. Initially not life-threatening, diaphragmatic ruptures can cause severe sequelae in the patient's long-term course if untreated. The objective of this study was to assess the epidemiology, associated injuries, and outcome of traumatic diaphragmatic ruptures based on a multicenter registry-based analysis. MATERIAL AND METHODS: Data from all patients enrolled in the TraumaRegister DGU® between 2009 and 2018 were retrospectively analyzed. That multicenter database collects data on prehospital, intra-hospital emergency, intensive care therapy, and discharge. Included were all patients with a Maximum Abbreviated Injury Scale (MAIS) score of 3 or above and patients with a MAIS score of 2 who died or were treated in the intensive care unit, for whom standard documentation forms had been completed and who had sustained a diaphragmatic rupture (AIS score of 3 or 4). The data has been analyzed using descriptive statistics and chi-square test or Mann-Whitney U test. RESULTS: Of the 199,933 patients included in the study population, 687 patients (0.3%) had a diaphragmatic rupture. Of these, 71.9% were male. The mean patient age was 46.1 years. Blunt trauma accounted for 73.5% of the injuries. Primary diagnosis was established in the resuscitation room in 93.1% of the patients. Multislice helical computed tomography (MSCT) was performed in 82.7% of the cases. Rib fractures were detected in 60.7% of the patients with a diaphragmatic injury. Patients with diaphragmatic rupture had a higher mean Injury Severity Score (ISS) than patients without a diaphragmatic injury (32.9 vs. 18.6) and a higher mortality rate (13.2% vs. 9.0%). CONCLUSIONS: In contrast to the literature, primary diagnostic procedures in the resuscitation room detected relevant diaphragmatic ruptures (AIS ≥ 3) in more than 90% of the patients in our study population. In addition, complex associated serial rib fractures are an important diagnostic indicator.

Delayed Presentation of Post-traumatic Multiorgan Left Diaphragmatic Hernia: A Case Report and Literature Review.

Post-traumatic diaphragmatic injuries can present as diaphragmatic hernia with herniation of abdominal viscera into the thoracic cavity. It is challenging for trauma surgeons to identify the delayed presentation of post-traumatic diaphragmatic injuries which require a high index of suspicion in patients who are at risk. We report a rare case of delayed diagnosis and management of post-traumatic diaphragmatic hernia in a polytrauma patient with a concise review of the literature. The patient presented after two years of post-traumatic thoracoabdominal injury due to a road traffic accident with breathing difficulty. On investigations, it was a large diaphragmatic hernia with herniation of abdominal contents into the left thoracic cavity. Laparotomy was performed with a reduction of abdominal contents from the left side of the chest along with mesh repair of the large diaphragmatic hernia. Postoperatively, the patient recovered well. The literature suggests that there should be a high level of suspicion of diaphragmatic injuries, especially when dealing with thoracoabdominal trauma or polytrauma patients. Post-traumatic diaphragmatic injuries, though rare, can lead to high morbidity or mortality if not treated on time.

An Unusual Source of Tension.

CASE PRESENTATION: A 67-year-old man with a history of hypertension, type 2 diabetes, and COPD requiring supplemental oxygen at baseline (4 L by nasal cannula) was admitted to the hospital for progressive dyspnea and dysphagia in the context of a newly diagnosed supraglottic mass.

Can invasive diagnostic methods be reduced by magnetic resonance imaging in the diagnosis of diaphragmatic injuries in left thoracoabdominal penetrating injuries?

Aim: In this study, we aimed to investigate the effect of magnetic resonance imaging (MRI) in detecting diaphragmatic injury by comparing preoperative computed tomography (CT) and MRI imaging results with diagnostic laparoscopy/thoracoscopy results in patients with left thoracoabdominal penetrating injury. We investigated whether MRI reduces the rate of unnecessary surgery by examining its sensitivity and specificity. Materials and Methods: Patients with left thoracoabdominal penetrating injuries who applied to the Emergency Surgery Unit of Istanbul University Istanbul Faculty of Medicine between November 2017 and December 2020 were evaluated. Patients who underwent emergency surgery, who could not undergo MRI or CT for any reason or who could not be operated on were excluded from the study. Preoperative MRI and CT images of patients who underwent diagnostic laparoscopy/thoracoscopy due to left thoracoabdominal injury in our clinic were evaluated retrospectively by a radiologist who did not know the surgical results. MRI results of the cases were compared with surgical findings and CT images. Results: A total of 43 (41 males, mean age: 31, range: 15-57) patients were included in the study. The most common physical examination finding was lateral injury. The diaphragmatic injury was detected in 13 (30%) cases during surgical interventions. Laparoscopic repair was performed in 11 (84%) cases and thoracoscopic repair was performed in 2 (15%) cases with diaphragmatic injuries. MRI images of 14 (32%) cases were found to be compatible with diaphragmatic injury, in 1 of them no injury was observed during surgical intervention. According to these data, the sensitivity of MRI was calculated as 100%, specificity 94%, positive predictive value 86%, and negative predictive value 100%. The mean hospital stay was 6 days (1-30) in all cases. Conclusion: In our study, MRI was found to have high specificity and sensitivity in detecting diaphragmatic injuries. The number of negative laparoscopy/thoracoscopy can be reduced by performing surgical intervention only in cases with positive or suspected diaphragmatic injury on MRI. Results should be supported by conducting new studies with larger case series with normal MRI findings and long follow-ups.

[Thoracoscopic repair of posttraumatic phrenic hernia in 62 years after injury of the diaphragm]. / Videotorakoskopicheskaya korrektsiya posttravmaticheskoi diafragmal'noi gryzhi cherez 62 goda posle raneniya grudobryushnoi pregrady.

Diagnosis of diaphragmatic injury is difficult in some cases. Symptoms of chronic posttraumatic diaphragmatic hernia are very diverse and associated with dysfunctions of the displaced abdominal organs and compression of thoracic organs. Previous blunt or open chest and abdominal trauma, as well as visible scars as a result of injury should be considered. Treatment concept assumes surgical correction of posttraumatic diaphragmatic hernia. Choice of surgical approach and type of intervention are determined individually. Despite the global trend towards minimally invasive endoscopic surgery, there are few reports on thoracoscopic correction of posttraumatic phrenic hernia. The authors report a rare case of thoracoscopic correction of posttraumatic diaphragmatic hernia in an 81-year-old man in 62 years after abdominal injury. Assuming degenerative changes in tissues and risk of defect enlargement following suture eruption, we used titanium nickelide reinforcing protectors. Video-assisted double port thoracoscopic access allowed minimally traumatic and successful correction of diaphragmatic hernia, that ensured early medical and social rehabilitation of the patient.