Penetran ve künt travmalara bağlı diyafragma yaralanmalarında multidedektör bilgisayarlı tomografi bulgularının değerlendirilmesi
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Amaç: Travmatik diafragma rüptürü, hem radyologların hemde cerrahların tanı koymada zorlandığı bir durumdur ve genellikle torakoabdominal bölgenin künt ve penetran travmaları sonucu oluşmaktadır. Erken tanınması ve cerrahi olarak onarılması hayati öneme sahiptir. Günümüzde artan trafik kazaları, kesici delici alet yaralanmaları ve ateşli silah yaralanmaları diyafragma rüptürü insidansında artışa yol açmaktadır. Biz bu çalışmada diyafragma rüptürü gelişen travma hastalarında travma çeşitlerini, diyafragma rüptürüne sekonder gelişen organ herniasyonlarını ve radyolojik olarak saptanan tanısal işaretleri, çok kesitli bilgisayarlı tomografi ile ortaya koymayı amaçladık. Gereç ve Yöntem: Dicle Üniversitesi Tıp Fakültesi Hastanesinde 2006-2012 yılları arasında, künt veya penetran torakoabdominal travma sonucu radyoloji kliniğinde 16 veya 64 dedektörlü bilgisayarlı tomografi cihazları ile çekimleri yapılmış ve diyafragma rüptürü nedeni ile cerrahi prosedür uygulanmış 56 hasta çalışmamıza dahil edildi. Hastaların görüntüleri iki deneyimli radyolog tarafından retrospektif değerlendirildi. Hastalar, yaş ve cinsiyet, yaralanma nedeni (penetran veya künt), yaralanan taraf, eşlik eden diğer organ yaralanmaları, diyafragma yaralanmasına sekonder gelişen organların intratorasik herniasyonu açısından değerlendirildi. Ayrıca diyafragma rüptürüne sekonder gelişen radyolojik işaretlerin sıklığı araştırıldı. Bulgular: Çalışmaya 45 erkek (% 80,3) ve 11 kadın (% 19,7) dahil edildi. Hastaların yaş ortalaması 33,9 ± 17,1 (4-84) yıl bulundu. Olgularımızın 37’si (% 66,1) penetran, 19’si (% 33,9) künt travmaya maruz kalmıştı. Travma sonucu 37 hastada (% 66,1) sol, 19 hastada (% 33,9) sağ hemidiyafragma yaralanmıştı. Hastaların tümünde eşlik eden organ yaralaması vardı ve en sık akciğer (% 51,7), daha sonra dalak (% 37,5) yaralanması mevcuttu. 25 (% 44,6) hastada eşlik eden organ herniyasyonu olup en sık kolon (% 60) sonra mide (% 48) herniye olmuştu. En sık radyolojik bulgu “defektin doğrudan izlenmesi’’ (% 53,6) olup takiben “Abdominal organ herniasyonu” (% 44,6), “diyafragmada kalınlaşma’’ (% 39,3) saptandı. Künt travmalarda (penetran travmalara oranla) diyafragma rüptüründe radyolojik bulguların sıklığı istatistiksel olarak anlamlı şekilde daha fazla bulundu. Sağ ve sol hemidiyafragma yaralanmaları karşılaştırıldığında künt ve penetran travmalarda diyafragma rüptürünü düşündüren radyolojik işaretler sol tarafta daha fazla saptandı. Sonuç: Radyolog, diyafragma rüptüründe radyolojik özel işaretlere aşina olmalıdır. Künt veya penetran torakoabdominal travmalarda, diyafragma rüptürünü düşündüren bulgular dikkatle değerlendirilmeli ve cerrah bu durum ile ilgili bilgilendirilmelidir. Anahtar kelimeler: Çok kesitli bilgisayarlı tomografi, Travma, Diyafragma rüptürü, Radyolojik işaretler,
Purpose: Traumatic diaphragmatic rupture is a diagnostic challange for both surgeons and radiologists and generally occurs secondary to blunt and penetrating trauma of thoracoabdominal region. Early recognition and surgical repair is vital. Nowadays, increasing traffic accident and the cross stab wounds, gunshot wounds lead to an increase in the incidence of diaphragmatic rupture. In this study, we aimed to define type of traumatic diaphragmatic rupture, organ herniation secondary to the diaphragmatic rupture and the diagnostic radiological signs by multislice computed tomography. Material and Methods: Fifty -six patients who anderwent surgical procedure due to blunt or penetrating trauma leading diaphragmatic rupture and visualized by 16- or 64- multidedector computed tomography at Radiology Department of Dicle University Medical Faculty between 2006-2012 were included to the study. The images of the patients were retrospectively evaluated by two experienced radiologists. Patients, age and gender, cause of injury (penetrating or blunt), injury site, accompanied by other organ injuries, secondary organ herniation were evaluated. We also investigated the incidence of radiological signs secondary todiaphragmatic rupture. Results: Forty five men (80,3%) and 11 women (19,7%) were included to the study. The mean age of patients was 33.9 ± 17.1 (4-84) years. 37 of the patients (66,1%)had penetrating and 19 (33,9%) had blunt trauma. Post-traumatic hemidiaphragm was in left 37 patients (66,1%) and the right side in 19 patients (33,9%). All of the patients had accompanying organ injuries, most common lung (51,7%), and spleen (37,5%) injuries. 25 (44,6%) patients had concomitant organ herniation, in the order of the colon (60%), the stomach (48%). The most common radiological findings were “Directly visualization of injury” (53,6%) and “ herniation of abdominal organs ” (44,6%) and “ diaphragmatic thickening ” (39,3%). In comparison of the left and right hemidiaphragm injuries in blunt and penetrating trauma, the radiological signs suggestive of diaphragmatic rupture were more frequent on the left side. Conclusion: The radiologist should be familiar with radiological signs of diaphragmatic rupture. Findings suggestive of diaphragmatic rupture must be carefully evaluated in patients with blunt or penetrating thoracoabdominal truma and the surgeon should be informed. Keywords: Multi-slice computed tomography, Trauma, Diaphragmatic rupture, Radiological signs.
Purpose: Traumatic diaphragmatic rupture is a diagnostic challange for both surgeons and radiologists and generally occurs secondary to blunt and penetrating trauma of thoracoabdominal region. Early recognition and surgical repair is vital. Nowadays, increasing traffic accident and the cross stab wounds, gunshot wounds lead to an increase in the incidence of diaphragmatic rupture. In this study, we aimed to define type of traumatic diaphragmatic rupture, organ herniation secondary to the diaphragmatic rupture and the diagnostic radiological signs by multislice computed tomography. Material and Methods: Fifty -six patients who anderwent surgical procedure due to blunt or penetrating trauma leading diaphragmatic rupture and visualized by 16- or 64- multidedector computed tomography at Radiology Department of Dicle University Medical Faculty between 2006-2012 were included to the study. The images of the patients were retrospectively evaluated by two experienced radiologists. Patients, age and gender, cause of injury (penetrating or blunt), injury site, accompanied by other organ injuries, secondary organ herniation were evaluated. We also investigated the incidence of radiological signs secondary todiaphragmatic rupture. Results: Forty five men (80,3%) and 11 women (19,7%) were included to the study. The mean age of patients was 33.9 ± 17.1 (4-84) years. 37 of the patients (66,1%)had penetrating and 19 (33,9%) had blunt trauma. Post-traumatic hemidiaphragm was in left 37 patients (66,1%) and the right side in 19 patients (33,9%). All of the patients had accompanying organ injuries, most common lung (51,7%), and spleen (37,5%) injuries. 25 (44,6%) patients had concomitant organ herniation, in the order of the colon (60%), the stomach (48%). The most common radiological findings were “Directly visualization of injury” (53,6%) and “ herniation of abdominal organs ” (44,6%) and “ diaphragmatic thickening ” (39,3%). In comparison of the left and right hemidiaphragm injuries in blunt and penetrating trauma, the radiological signs suggestive of diaphragmatic rupture were more frequent on the left side. Conclusion: The radiologist should be familiar with radiological signs of diaphragmatic rupture. Findings suggestive of diaphragmatic rupture must be carefully evaluated in patients with blunt or penetrating thoracoabdominal truma and the surgeon should be informed. Keywords: Multi-slice computed tomography, Trauma, Diaphragmatic rupture, Radiological signs.
Açıklama
Anahtar Kelimeler
Çok kesitli bilgisayarlı tomografi, Multi-slice computed tomography, Travma, Trauma, Diyafragma rüptürü, Diaphragmatic rupture, Radyolojik işaretler, Radiological signs, Diyafram, Diaphragm