Introduction: Detection of diaphragmatic injury in blunt trauma can be challenging in the absence of surgical exploration. Here we explore the mechanisms of injury and detection modes for patients with blunt trauma who had a diaphragmatic injury. Methods: This is a single-center, retrospective review conducted in a level 1 trauma center, 2016 to 2023, inclusive. We included all patients who presented with a blunt traumatic diaphragm injury (TDI). We identified nine patients with TDI using AIS injury description and type of trauma. Patient demographics, mechanism of injury, injury severity score (ISS), mode of diagnosis, and clinical outcomes were reviewed. Results: Of the nine patients identified with blunt TDI, two were associated with motor vehicle collisions, four were pedestrians struck, 1 from stab wounds, and 2 fell from the stairs. The mean ISS for the nine patients is 39.7. Of the nine patients with blunt TDI, four died in the trauma bay – two from traumatic arrest, and two died spontaneously. One patient died two days after admission. Of the four patients who survived, one had a diaphragm injury identified during video-assisted thoracic surgery (VATS) for retained hemothorax, and one patient had a diaphragm injury repaired during emergent exploratory laparotomy for other injuries. One patient had a diaphragm injury identified and repaired during diagnostic laparoscopy that was converted to open surgery, and the remaining patient had no diaphragm injury on diagnostic laparoscopy evaluation. Conclusions: Blunt trauma to the torso is usually a consequence of high-energy impact but can also occur following low-energy incidents, such as falls in elderly individuals. Imaging can be useful in detecting such injuries but is not 100% sensitive. A high index of suspicion should be maintained for diaphragmatic injury in high-energy blunt trauma.

An 18-month-old neutered male domestic shorthair cat was presented for an emergency consultation after falling from the second floor. The cat sustained minor traumatic injuries but did not exhibit any dyspnea. Routine radiographic examination raised suspicion of a diaphragmatic hernia, but the circumscribed nature of the soft tissues visible in the thorax was atypical for a classic traumatic diaphragmatic hernia. A positive contrast peritoneography highlighted the likely presence of a hernial sac, which strongly suggested a “true diaphragmatic hernia” also known as “pleuroperitoneal hernia”. This diagnosis was confirmed during laparotomy, which allowed the visualization of a 3 cm radial diaphragmatic defect in the right ventral quadrant of the pars sternalis. The diaphragm's edges were rounded. A portion of the falciform ligament and a part of the omentum were protruding through the defect and were contained within a hernial sac. Herniorrhaphy was performed. The cat recovered without complications. Given its presentation and location, ventrally and to the right, this anomaly is analogous to what is described in humans as “Morgagni hernia”. We believe that 6 other cases of Morgagni hernias have been reported in cats but were not identified as such. This case underscores the utility of peritoneography, a straightforward technique usefull for diagnosing diaphragmatic hernias, which enables differentiation between acquired traumatic forms and congenital forms, particularly pericardoperitoneal hernias and pleuroperitoneal hernias. True diaphragmatic hernias are almost always serendipitous discoveries.

Traumatic cardiac arrest has a high mortality. We report the case of a 65 years old women who presented a cardiac arrest following traffic accident. Examinations concluded to a tension gastro thorax with a delayed diagnosis. Naso gastric tube insertion was for many authors a temporary care while waiting for surgery. We report on the diagnostic difficulties found in the literature and a recent review of published cases.

Background: This study presents the experience gained in the Newborn Intensive Care Unit (NICU) at “M. S. Curie” Emergency Clinical Hospital for Children in Bucharest after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We evaluate the advantages, complications, immediate and long-term outcome as well as the morbidity. Methods: We conducted a retrospective analysis of the data for all patients operated on-site be-tween 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, com-plications and outcomes. Results: Our study is based on data from ten cases of newborns, term or small for gestation age with birthweights ranging from 2300 to 3300 grams, operated, on average, on the fifth day of life. The main reasons for operating on-site were the hemodynamical instability and the need to ad-minister inhaled Nitic Oxide (iNO) and HFOV ventilation. There were no unforeseen events dur-ing surgery, no immediate postoperative complications and no surgery related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Conclusions: Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications could be associated with this practice. Keywords: congenital diaphragmatic hernia, severe pulmonary hypertension, bedside surgery, NICU infrastructure

Lethal congenital contracture syndrome 11 (LCCS11) is a form of arthrogryposis multiplex congenita (AMC) which is associated with mutations in the gliomedin gene (GLDN) and has been known to be severely life-shortening, mainly due to respiratory insufficiency. Patients with this condition have been predominantly treated by pediatricians as they usually do not survive beyond childhood. In this case report we present a young adult who developed severe progressive respiratory insufficiency as a teenager due to diaphragmatic hypomotility and was diagnosed with LCCS11 following the finding of compound heterozygous pathogenic variants in GLDN. This case demonstrates the importance of screening for neuromuscular diseases in well-child visits and follow-ups of patients at risk for gross and fine motor function developmental delay. It also underscores the significance of including LCCS11 and other axonopathies in the differential diagnosis of juvenile onset of respiratory insufficiency, highlights that patients with this condition may present to adult practitioners and questions whether the nomenclature of this condition with various phenotypes should be reconsidered due to the stigmatizing term ‘lethal’.