Confirmation of the Contribution of Radiological Imaging Methods in Diaphragmatic Pathologies

Aim: The aim of the present study was to review clinical findings, radiological methods, and postoperative outcomes in patients who underwent an operation at our clinic due to diaphragmatic hernia. Material and Method: The medical records of 35 patients, who were operated on due to benign diaphragmatic hernia between January 2007 and June 2014, were retrospectively reviewed. The patients had been particularly evaluated using lateral and posteroanterior chest radiographies in the preoperative period. Other imaging modalities that were employed when required were computerized tomography, ultrasonography, and magnetic resonance imaging. The patients were divided into three groups: 10 (28.6%) had congenital diaphragmatic hernia, 16 (45.7%) had traumatic diaphragmatic hernia, and 9 (25.7%) had diaphragmatic eventration. Results: The mean age of the patients was 40.9±13.8 years (range 14 %u2013 66 years). Of the patients, 24 were males and 11 were females. Six patients (17.1%) underwent emergency thoracotomy procedure, and the remaining patients underwent an operation under elective conditions after preoperative assessment. None of the patients required the use of patch in the repair of defects. The imaging method was unable to establish a diagnosis in 13 of 27 patients who underwent computerized tomography, 14 of 22 patients who underwent ultrasonography, and 3 of 18 patients who underwent magnetic resonance imaging. When the groups were evaluated, magnetic resonance imaging was superior in diagnosing congenital diaphragmatic hernia, ultrasonography was superior in diagnosing diaphragmatic eventration, and computerized tomography was superior in diagnosing traumatic diaphragmatic laceration. A re-thoracotomy was required in three patients (8.5%) due to postoperative hemorrhage. One patient, who underwent emergency thoracotomy due to diaphragmatic, pulmonary and splenic laceration after sustaining a stab wound, died in the early period (operative mortality was 2.9%). Discussion: Despite the advances in radiological methods, the efficiency of radiological methods has not reached desired level in cases that are suspected to have a diaphragmatic pathology. In the present study, MR imaging yielded more valuable results compared to other imaging modalities in surgically confirmed cases. We therefore suggest that a holistic approach should be adopted while evaluating clinical and radiological data