Double jeopardy: The aortic-diaphragmatic injury complex.

Objective: Concurrent traumatic diaphragmatic hernia (TDH) and blunt thoracic aortic injury (BTAI) are rare but critical injury complexes that result from high-energy trauma mechanisms. This study analyzed the epidemiology, diagnostic approaches, risk factors, and outcomes of concurrent TDH and BTAI and proposed a structured treatment algorithm.

Material and methods: A retrospective analysis was performed using trauma records from a level 1 trauma center (2004-2024). Four male patients with confirmed concurrent TDH and BTAI were included in the study. Data on demographics, injury characteristics, diagnostic methods, treatment, and outcomes were collected. Statistical analyses were conducted using appropriate tests.

Results: All injuries were caused by high-energy traumas. Mean injury severity score was 38 and the revised trauma score was 6.58. A massive transfusion protocol was activated in 75.0% of cases. Diagnostic imaging showed varying accuracies, with computed tomography demonstrating superior sensitivity for both injuries. All TDH were left-sided posterolateral and BTAI predominantly involved the isthmus. Management followed a sequential approach, with 75.0% of diaphragmatic repairs preceding the aortic intervention. Mean hospital stay was 33 days, with complications including infections, deep vein thrombosis, and atelectasis. Despite the high severity of the injury, all patients survived.

Conclusion: Concurrent TDH and BTAI are rare, but critical injury complexes. Early recognition through structured diagnostic protocols and sequential management guided by institutional capabilities can achieve favorable outcomes despite high injury severity.