Laceration of the Diaphragm: An Autopsy Series

Abstract

In the surgical literature, laceration of the diaphragm is reported three times more often on the left side than the right, and bilateral lacerations are uncommon. However, in reported autopsy series, right, left, and bilateral lacerations occur at approximately equal frequencies. Few reports mention lacerations of the diaphragmatic crura. This retrospective case series describes the spectrum of autopsy findings in subjects with diaphragmatic lacerations and includes lacerations of the crura. Methods Records were reviewed from a consecutive series of 145 autopsies on subjects who died in traffic accidents or falls or leaps from a great height. The diagnostic standard was direct observation at autopsy. Results Twenty-two subjects had laceration of the diaphragm. Of these, four had a right leaf laceration, five had left leaf laceration, five had bilateral leaf lacerations, and nine had crural lacerations. Eight subjects with leaf lacerations also had herniations of viscera through the laceration. The lacerations ranged in length from 4 to 20 cm. All subjects sustained additional trauma to the torso. Nineteen of 22 subjects died of severe central nervous system trauma, cardiac or aortic trauma, or both. Conclusions Lacerations of the diaphragmatic crura are more common than previously reported. The incidence of right, left, and bilateral leaf lacerations is similar to that reported in other autopsy series. Lacerations of the diaphragm are associated with severe trauma of the central nervous system, heart, and aorta.