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

Abstract

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.

Complication of hemothorax after CT-guided percutaneous biopsy of herniated liver masquerading as a pulmonary mass

“…In the setting of multiple pulmonary nodules, the largest and most percutaneously accessible lesion is usually targeted for biopsy. In this case, it was unrecognized that the pulmonary nodule abutting the diaphragm displayed the “band” sign, “hump” sign [3] , [4] , and a portal vein branch extending into the tissue. Hemothorax after percutaneous lung biopsy is most often attributed to intercostal artery injury [5] .…”

“…The pathology results from the biopsy showed “fragments of benign liver parenchyma with mild triaditis and separate fragments of benign alveolar lung parenchyma; no evidence of malignancy.” The patient went on to be diagnosed with stage IV adenocarcinoma consistent with bronchogenic origin with metastasis to the L4 vertebra. After retrospective review of the CT images (which were performed and interpreted at an outside institution), post-IV contrast images in a soft tissue window demonstrated the reported “right lower lobe lobulated lung mass” to display both the band sign [3] , [4] and hump sign [3] , [4] , and portal vein branches within the tissue ( Fig. 6 ).…”

Paediatric traumatic rupture of the diaphragm

“…Traumatic diaphragmatic rupture (TDR) in the presence of other injuries and owing to its rarity may be easily missed in children (1,2). When presentation is delayed, morbidity and mortality rates increase proportionately (1,2). TDR may mimic conditions such as pneumothorax and bowel obstruction.…”

Patient Characteristics and Outcomes Following Operative Repair of Acute versus Chronic Traumatic Diaphragmatic Hernia

“…Diaphragmatic hernia is a rare but serious complication of trauma that may lead to significant morbidity and mortality if unrecognized. Conservative estimates suggest that the incidence of diaphragmatic injury is 0.8%-8% from blunt abdominal trauma and 10%-15% after penetrating trauma, with more extensive diaphragmatic injuries associated with blunt trauma [1][2][3][4]. The true incidence of traumatic diaphragmatic hernia (TDH) remains uncertain as the wide variety in clinical presentations leads to diagnostic challenges [1,2,[5][6][7][8].…”

“…Despite the numerous radiologic and surgical approaches utilized, the diagnosis is frequently missed. The diagnostic challenge has been attributed to asymptomatic presentations, more distinct and urgent concomitant injuries, positive pressure in the chest due to intubation, and visceral "plugging" over the diaphragmatic defect [2,5,8]. The literature suggests that a high index of suspicion is most important to allow for early diagnosis of traumatic diaphragmatic hernia (TDH) [9,10].…”