Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma Richard K Freeman, MD, Ghanam.

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Presentation transcript:

Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma Richard K Freeman, MD, Ghanam Al-Dossari, MD, Kelley A Hutcheson, BS, Lynn Huber, RN, Michael E Jessen, MD, Dan M Meyer, MD, Michael A Wait, MD, J.Michael DiMaio, MD The Annals of Thoracic Surgery Volume 72, Issue 2, Pages 342-347 (August 2001) DOI: 10.1016/S0003-4975(01)02803-X

Fig 1 Entrance wound locations. (A) Front; (B) back. Numerator depicts the number of diaphragm injuries. Denominator depicts the total number of entrance wounds in that area. The Annals of Thoracic Surgery 2001 72, 342-347DOI: (10.1016/S0003-4975(01)02803-X)

Fig 2 Diagnostic algorithm for diaphragm injuries following penetrating chest trauma. (1 = The chest is immediately evaluated with an upright chest x-ray (CXR); 2 = The abdomen is evaluated for injury utilizing diagnostic peritoneal lavage (DPL) or computed tomographic (CT) imaging; 3 = Patients with an indication for celiotomy or thoracotomy have their diaphragm evaluated at the time of surgery. VATS = video assisted thoracoscopic surgery.) The Annals of Thoracic Surgery 2001 72, 342-347DOI: (10.1016/S0003-4975(01)02803-X)

Fig 3 Diagnostic algorithm for diaphragm injuries (DI) following penetrating chest trauma. (1 = Patients whose history or physical exam identifies two or more (≥ 2) predictors of DI should undergo video-assisted thoracoscopy to exclude an occult DI; 2 = Patients with less than two (< 2) independent predictors of DI have a risk of occult diaphragm injury too low to justify the routine use of video-assisted thoracoscopic surgery (VATS). Abd = abdomen; CXR = chest x-ray; MRI = magnetic resonance imaging.) The Annals of Thoracic Surgery 2001 72, 342-347DOI: (10.1016/S0003-4975(01)02803-X)