Diaph rupture pdf case

CASE

FINDINGS
Left diaphragmatic rupture

DIAPHRAGMATIC RUPTURE
•Blunt trauma (6% of patients after major blunt
trauma)
•Penetrating trauma
• If the diagnosis is missed, patients may develop
intrathoracic herniation and strangulation , with
morbility and mortality of up to 50%

CT FINDINGS 2002: 7
Variable Sensitivity Specificity
Collar sign 24 100
Direct visualization
of injury
36 95
Thick crus 36 77
Dependent
viscera sign
Herniation without
collar sign
52 71
8 95
Trajectory 36 100
Active
extravasation of
contrast material
8 100
Larici et al, AJR 2002;179:451451-457

CT FINDINGS 2012:19

CT SIGNS
DIRECT SIGNS
• Segmental Diaphragmatic defect
• Dandgling diaphragm
• Absent diaphragm sign
INDIRECT SIGNS (related
to herniation)
• Herniation through a defect sign
• Collar sign
• Hump and Band signs
• Dependent viscera
• Sinus cutoff sign
• Abdominal content peripheral to
the diaphragm or to the lung
• Elevated abdominal organ signs

• INDIRECT SIGNS RELATED TO LOSS OF THE
BORDER BETWEEN THE THORAX AND ABDOMEN
• CT SIGNS OF UNCERTAIN OR CONTROVERSIAL
ORIGIN
• Thickening of the diaphragm sign
• Diaphragmatic or peridiaphragmatic contrast medium
extravasation
• Hypoenhanced diaphragm sign
• Fractured rib
INDIRECT OR
CONTROVERSIAL SIGNS

Waistlike constriction of
stomach suggesting
herniation of the stomach
through injured
diaphragm (Collar sign)
Larici et al, AJR 2002;179:451451-457

Because the patient lie supine
at CT examination, if the
diaphragm has been ruptured,
the herniated viscera (bowel or
solid organs) are no longer
supported posteriorly by the
injured diaphragm and fall to a
dependent position against
posterior ribs. (Dependent
Viscera Sign)
Bergin et al,AJR 2001;177:1137-1140

Diaphragmatic discontinuity
and active arterial
extravasation
Notes: The entire diaphragm often cannot be completely visualized with crosssectional
imaging. Posterolateral diaphragmatic defect are seen at CT in
approximately 6% of healthy adults.
Larici et al, AJR 2002;179:451451-457

…be prepared to suggest the presence of an
injury on the basis of a single CT finding!!
Coronal and sagittal reformatted images
could be “helpful”.