Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

Abstract

Diagnosis of traumatic diaphragmatic hernia due to blunt abdominal trauma requires a high index of suspicion. This study was conducted to assess the accuracy of multidetector computed tomogram (MDCT) in the diagnosis of traumatic diaphragmatic hernia. All patients with thoracoabdominal blunt trauma with diaphragmatic hernia diagnosed on radiologic evaluation during a 3-year period (i.e., from June 2004 to June 2007) were analyzed. Nineteen patients with diaphragmatic injuries in 117 patients with blunt thoracoabdominal injury (16.23%) were studied. Age range was 8-60 years (mean 34 years). Male-female ratio was 18:1. Various features seen on CT scan were diaphragmatic discontinuity in 13 (68.42%), thickened diaphragm in 10 (52.63%), "collar sign" in 8 (42.10%), visceral herniation in 12 (63.15%), dependent viscera sign in 8 (42.10%), and segmental nonrecognition of the diaphragm in 1 patient (5.88%). Two patients presented with delayed rupture. In the rest mean duration between time of injury and performance of CT scan was 44.35 h (range 3-288 h). Fourteen patients underwent operative management. Sensitivity, specificity, and accuracy of MDCT scan were 100, 93, and 95%, respectively. Three patients (15.78%) expired. MDCT is a highly accurate modality for detecting traumatic diaphragmatic hernia.

Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis

“…In previous reports, the stomach was the most frequently herniating organ, followed by the spleen, small bowel, and so forth. [6][7][8][9][10][11][12][13] Moreover, a maximum of 1-2 visceral organs were reported in such diaphragmatic hernias; however, in our patient, we noted the unusual herniation of multiple viscera into the left thoracic space. Therefore, we made further incisions in the diaphragm to return the viscera safely into the abdominal cavity without bleeding, especially from the spleen.…”

“…5 Subsequently, many reports have described this condition, with the stomach being the most frequently herniating organ, followed by the spleen, small bowel, and so forth. [6][7][8][9][10][11][12][13] However, few studies have reported multiple viscera herniating into the chest simultaneously. Further, no reports have described the occurrence of bacterial pleuritis in combination with diaphragmatic hernia without perforation or necrosis.…”

Traumatic intrapericardial diaphragmatic hernia: findings on a computed tomography scan

“…Characteristic findings such as diaphragmatic discontinuity, visceral herniation and waistlike constriction of bowel (‘collar sign’) were detectable in our case (Fig. ) . Echocardiography is useful when cardiac tamponade is suspected .…”

“…). CT scans have reported higher sensitivity, specificity or accuracy . Characteristic findings such as diaphragmatic discontinuity, visceral herniation and waistlike constriction of bowel (‘collar sign’) were detectable in our case (Fig.…”

Is non-operative approach applicable for penetrating injuries of the left thoraco-abdominal region?

“…noted that the sensitivity, specificity, and accuracy rates of multi-detector CT were 100%, 93%, and 95%, respectively, in the diagnosis of traumatic diaphragmatic hernias. 22 Some studies have shown that diagnostic laparoscopy has an accuracy rate of 98–100% in detecting diaphragm injuries with peritoneal penetration. 23 The diagnostic rates of CT for diaphragmatic injuries in the study conducted by Magu et al.…”