MDCT diagnosis of penetrating diaphragm injury

Abstract

The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted. These signs were correlated with surgical diagnoses, and their sensitivity and specificity in assisting the diagnosis were calculated. CT confirmed diaphragmatic injury in 41 of 47 injuries (sensitivity, 87.2%), and an intact diaphragm in 71 of 98 patients (specificity, 72.4%). The overall accuracy of MDCT was 77%. The most accurate sign helping the diagnosis was contiguous injury on either side of the diaphragm in single-entry penetrating trauma (sensitivity, 88%; specificity, 82%). Thus MDCT has high sensitivity and good specificity in detecting penetrating diaphragmatic injuries.

Delayed presentation of posttraumatic diaphragmatic hernia

“…A recent report with the use of multidetector CT in penetrating diaphragmatic injuries has shown promising results, with sensitivity, specificity and accuracy rates of 87%, 72% and 77%, respectively. [17] Although chest X-ray findings in delayed presentation were more diagnostic than in acute admission in this study and in others, [10] since most patients without acute symptoms had long-term complaints, additional diagnostic tests other than chest X-ray were routinely used. While older case series used upper gastrointestinal (GI) contrast studies, [11] recent reports commonly used CT or MRI.…”

The diagnostic efficacy of Computed Tomography in detecting diaphragmatic injury secondary to thoracoabdominal penetrating traumas: a comparison with diagnostic laparoscopy

“…[2] We observed that focal or diffuse diaphragmatic thickening had a low sensitivity and specificity for the detection of diaphragmatic injury. It has also previously been reported that this was a non-specific sign for penetrating traumas.…”

“…Discontinuous diaphragm sign, thickening of the diaphragm, hypoattenuated diaphragm, dependent viscera sign, dangling diaphragm sign, collar sign, contiguous injury sign, sinus cut-off sign, and diaphragmatic/peridiaphragmatic contrast extravasation are the well-defined CT signs of blunt and penetrating traumas. [2,3,14] Identification of these signs would provide valuable information in the diagnostic process. Most previous studies contained patient populations focused on blunt traumas or mixed series.…”

“…It has also previously been reported that this was a non-specific sign for penetrating traumas. [2] This may be attributed to possible differences in diaphragmatic thickness in its different regions, as well as possible variability in its appearance in different subjects. [14] In addition, it has been reported that this sign is specific for blunt traumas rather than penetrating traumas.…”

“…In emergency departments; however, CT is regarded as the imaging test of choice owing to its ability to rapidly detect even small defects with the help of multiplanar reconstruction images. [2,3] There are only a few studies that have specifically focused on diaphragmatic injuries caused by sharp penetrating objects. This study, by retrospectively reviewing MDCT scans, aimed to determine the diagnostic efficacy of multidetector computed tomography (MDCT) for diaphragmatic injuries in patients presenting with left thoracoabdominal penetrating sharp object injury in which diaphragmatic injury was evaluated by laparoscopy.…”