Helical CT with Sagittal and Coronal Reconstructions: Accuracy for Detection of Diaphragmatic Injury

Abstract

Helical CT shows good sensitivity, specificity, and accuracy for the diagnosis of diaphragmatic injury. Coronal and sagittal reconstructions are of limited use in establishing or refuting this diagnosis. Active arterial extravasation of contrast material near the diaphragm should raise suspicion for injury. Crus measurements cannot be used to reliably distinguish between injured and uninjured diaphragms.

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

“…Other signs described in the literature are contrast medium extravasation at the level of the diaphragm described by Larici et al [11] and hypoattenuation of the hemidiaphragm due to devascularization described by Nachimi et al [18]. Nachimi et al found 0% sensitivity for the first sign, as also seen in our series.…”

“…Both Killeen et al [16] and Larici et al [11] found that helical CT performed better for the left-sided injuries, while we found the sensitivity and specificity to be equal on both sides. Also, in contrast to Killeen et al [16], Larici et al [11] found that sagittal and coronal reformation added little to the ability to diagnose diaphragmatic injury.…”

“…Also, in contrast to Killeen et al [16], Larici et al [11] found that sagittal and coronal reformation added little to the ability to diagnose diaphragmatic injury. It was helpful only in three of our cases.…”

“…The incidence of diaphragmatic rupture varies from 0.8 to 8% following major blunt trauma [9][10][11]. Sennertus was the first to describe a traumatic diaphragmatic hernia in 1541 [4,12].…”

“…Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy reported by various authors [5,11,16,18] are shown in Table 3. Findings are comparable with the findings of our study.…”