Imaging of the Diaphragm
The diaphragm is a critical musculotendinous structure that contributes to respiratory function. Disorders of the diaphragm are rare and diagnostically challenging. Herein, the author reviews the radiologic options for the assessment of the diaphragm. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 12, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Erin A. Gillaspie Source Type: research

Management of Traumatic Diaphragmatic Injuries
Diaphragm injuries are rarely seen injuries in trauma patients and are difficult to diagnose. With improving technology, computed tomography has become more reliable, but with increasing rates of non-operative management of both penetrating and blunt trauma, the rate of missed diaphragmatic injury has increased. The long-term complications of missed injury include bowel obstruction and perforation, which can carry a mortality rate as high as 85%. When diagnosed, injuries should be repaired to reduce the risk of future complications. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 24, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Devin Gillaspie, Erin A. Gillaspie Source Type: research

Management of Diaphragm Tumors
Diaphragm tumors are very rare, with secondary tumors being more common than primary tumors. The most common benign primary tumors include lipomas and cysts, and malignant primary tumors include rhabdomyosarcoma and leiomyosarcoma. Endometriosis is the most common benign secondary tumor, followed by malignant tumors with localized spread of disease. In addition, widely metastatic disease has been described. Benign lipomas and cysts can be managed conservatively, but more complex or concerning disease typically requires resection. The diaphragm can often be repaired primarily, though any large defect or tension would indica...
Source: Thoracic Surgery Clinics - February 24, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Marta Engelking, Madhuri Rao Source Type: research

Delving into the Diaphragm
The diaphragm serves many purposes in the body. While classically, the diaphragm is thought of as a critical muscle of respiration, and it is, the diaphragm serves a plethora of functions. This musculotendinous structure with its unique dome shape serves as an anatomic barrier between the abdomen and the chest, aids in the flow of blood and lymph, and even assists in the function of our gastrointestinal (GI) and genitourinary systems. Therefore, when the diaphragm sustains a traumatic injury, neurologic dysfunction, or diseases such as cancer or hernias, the impacts can manifest throughout the body. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 24, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Erin A. Gillaspie Tags: Preface Source Type: research

Diaphragmatic Defects in Infants
Congenital diaphragmatic hernia (CDH) is a complex and highly variable disease process that should be treated at institutions with multidisciplinary teams designed for their care. Treatment in the neonatal period focuses on pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction. Extracorporeal membrane oxygenation (ECMO) can be considered in patients refractory to medical management. Repair of CDH early during the ECMO course seems to improve mortality compared with other times for surgical intervention. The choice of surgical approach to CDH repair should consider the patient ’s physiologic status and the...
Source: Thoracic Surgery Clinics - February 17, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Robert J. Vandewalle, Lawrence E. Greiten Source Type: research

Management of Diaphragm Paralysis and Eventration
An elevated diaphragm may be due to eventration or paralysis. Diaphragm elevation is often asymptomatic and found incidentally on imaging. Fluoroscopic testing can be used to differentiate eventration (no paradoxic motion) from paralysis (paradoxic motion). Regardless of etiology, a diaphragm plication is indicated in all symptomatic patients with an elevated diaphragm. Plication can be approached either from a thoracic or abdominal approach, though most thoracic surgeons perform minimally invasive thoracoscopic plication. The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphrag...
Source: Thoracic Surgery Clinics - February 17, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Camille Yongue, Travis C. Geraci, Stephanie H. Chang Source Type: research

Congenital Hernias in Adults
Bochdalek hernias are a rare occurrence in adults and usually asymptomatic, resulting in incidental discovery. However, surgical intervention is recommended for both symptomatic and asymptomatic Bochdalek hernias due to the risk of acute morbidity and mortality. There are various possible surgical approaches that may be appropriate depending on the circumstance, with robotic repair becoming increasingly popular. To date, the rarity of the condition has limited the available data on postoperative outcomes. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 17, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Connor J. Bridges, Rian M. Hasson Source Type: research

Surgical Diaphragm
The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining gastrointestinal function. A careful consideration of anatomy should be taken during surgical procedures to minimize injury to this crucial organ. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 15, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Sadia Tasnim, Alejandro C. Bribriesco, Monisha Sudarshan Source Type: research

Management of Congenital Hernias in Adults
Morgagni hernias may range from asymptomatic incidental findings to surgical emergencies. An abdominal approach is ideal in the majority of cases, although surgeons should understand alternatives for repair. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - February 15, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Nicolas Contreras, Thomas K. Varghese, Brian Mitzman Source Type: research

Management of Paraesophageal Hernias
Paraesophageal hernias are classified according to the altered anatomic relationships between the gastroesophageal junction or stomach and the diaphragmatic hiatus. Herniation of these structures into the mediastinum may produce common complaints such as reflux, chest pain, and dysphagia. The elective repair of these hernias is well tolerated and significantly improves quality of life among patients with symptomatic disease. The hallmarks of a quality repair include the circumferential mobilization of the esophagus to generate 3  cm of tension-free intra-abdominal length and the performance of a fundoplication. (Source: T...
Source: Thoracic Surgery Clinics - February 15, 2024 Category: Cardiovascular & Thoracic Surgery Authors: Ryan J. Randle, Douglas Z. Liou, Natalie S. Lui Source Type: research

Personal Finance Wellness for New Attendings
New attending surgeons should consider hiring a Certified Financial Planner with experience in the surgical profession while also utilizing accessible resources to improve their financial literacy. They should acquire adequate life and disability insurance, devise debt-repayment strategies, and plan for retirement by contributing to tax-advantaged accounts and diversifying investments. New attending surgeons should also be cognizant of the financial implications of important personal life events, such as marriage and childbirth. Having a financial team is important, and this may consist of a financial advisor and surgeon m...
Source: Thoracic Surgery Clinics - November 11, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Russell Seth Martins, Kostantinos Poulikidis, Faiz Y. Bhora Source Type: research

The Professional Lifespan:   From Residency to Retirement
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2023 Category: Cardiovascular & Thoracic Surgery Authors: Jinny S. Ha, Stephen C. Yang Source Type: research

Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2023 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contributors
VIRGINIA R. LITLE, MD (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2023 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
Virginia R. Litle (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 11, 2023 Category: Cardiovascular & Thoracic Surgery Source Type: research