Which sign would indicate diaphragmatic injury after trauma?

Which sign would indicate diaphragmatic injury after trauma?

• A. Positive bowel sounds in the thoracic cavity
• B. Nasogastric tube coiled in thorax
• C. Absent breath sounds
• D. Tracheal shift

Answer: (A)

When a diaphragm is torn, abdominal contents can move into the chest, and a classic bedside clue is hearing bowel sounds in the thoracic cavity. This occurs because loops of bowel have herniated into the chest through the rupture, so auscultation over the lung field unexpectedly picks up intestinal noises. That finding is highly specific for diaphragmatic injury after trauma and should prompt urgent imaging and surgical consultation. Other signs can point to different chest injuries. Absent breath sounds can occur with large pneumothorax or major lung injury, not specifically diaphragm rupture. A tracheal shift suggests a mass effect from conditions like tension pneumothorax or large effusions, not diaphragmatic rupture alone. A nasogastric tube coiling in the thorax would indicate herniation of the stomach, which can occur with diaphragmatic rupture but requires placement of a tube and isn’t as immediate a bedside clue as hearing bowel sounds in the chest.

When a diaphragm is torn, abdominal contents can move into the chest, and a classic bedside clue is hearing bowel sounds in the thoracic cavity. This occurs because loops of bowel have herniated into the chest through the rupture, so auscultation over the lung field unexpectedly picks up intestinal noises. That finding is highly specific for diaphragmatic injury after trauma and should prompt urgent imaging and surgical consultation.

Other signs can point to different chest injuries. Absent breath sounds can occur with large pneumothorax or major lung injury, not specifically diaphragm rupture. A tracheal shift suggests a mass effect from conditions like tension pneumothorax or large effusions, not diaphragmatic rupture alone. A nasogastric tube coiling in the thorax would indicate herniation of the stomach, which can occur with diaphragmatic rupture but requires placement of a tube and isn’t as immediate a bedside clue as hearing bowel sounds in the chest.