Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

Kaya, Şeyda Örs; Karabulut, Nevzat; Yuncu, Gökhan; Sevinç, Serpil; Kıroğlu, Yılmaz

doi:10.1016/j.ejrad.2006.04.015

Cited by 11 publications

(6 citation statements)

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“…The dependent viscera sign[34] (Figure 9) (also referred to as sinus cutoff sign[35]) was first described by Bergin et al[34] in 2001 and is represented by an anomalous contact between abdominal viscera and posterior chest wall, without the physiological lung parenchyma interposition. It is the consequence of the loss of the diaphragmatic support to the abdominal organs that, therefore, in the supine position tend to lie dorsally.…”

Section: Imaging Of Bdlmentioning

confidence: 99%

Blunt diaphragmatic lesions: Imaging findings and pitfalls

Bonatti

Lombardo

Vezzali

et al. 2016

WJR

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Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.

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Section: Imaging Of Bdlmentioning

confidence: 99%

Blunt diaphragmatic lesions: Imaging findings and pitfalls

Bonatti

Lombardo

Vezzali

et al. 2016

WJR

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“…In case of large quantities of fluid (blood) within the pleura, the displaced organs would not be located adjacent to the posterior thoracic wall. If the pleural fluid is visualized medially in relation to the displaced organs or is divided by these organs, the presentation is referred to as sinus cut-off sign [7]. …”

Section: Resultsmentioning

confidence: 99%

The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma

et al. 2016

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SummaryBackgroundDiaphragmatic injuries occur in 0.8–8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries.Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications.The aim of this study was to present radiological findings in patients with diaphragmatic injury.Material/MethodsThe analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture.The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign).ResultsIn our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively.In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed.Other signs were less common.ConclusionsThe knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.

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“…23) Dependent viscera sign (see Fig. 23), loss of the diaphragmatic support and subsequent dependent positioning of an organ against the posterior thoracic wall in supine patients Segmental diaphragmatic defect sign, a focal diaphragmatic defect Sinus cutoff sign, herniated organs conform to dependent viscera sign interrupting pleural fluid in costophrenic sinus 47 Dangling diaphragm sign, torn free edge of diaphragm hangs and conforms to comma shape 45 Visualization of contrast media extravasation from the diaphragm Elevated diaphragm and abdominal organs Pneumothorax associated with pneumoperitoneum Hemothorax associated with hemoperitoneum …”

Section: Discontinuous Diaphragm Signmentioning

confidence: 97%