Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to present the frequency of computed tomography (CT) signs of diaphragmatic rupture and the differences between blunt and penetrating trauma. MATERIALS AND METHODSThe CT scans of 23 patients with surgically proven diaphragmatic tears (both blunt and penetrating) were retrospectively reviewed for previously described CT signs of diaphragmatic injuries. The overall frequency of CT signs was reported; frequency of signs in right-and left-sided injuries and blunt and penetrating trauma were separately tabulated and statistically compared. RESULTSThe discontinuous diaphragm sign was the most common sign, observed in 95.7% of patients, followed by diaphragmatic thickening (69.6%). While the dependent viscera sign and collar sign were exclusively observed in blunt-trauma patients, organ herniation (P = 0.05) and dangling diaphragm (P = 0.0086) signs were observed significantly more often in blunt trauma than in penetrating trauma. Contiguous injury on either side of the diaphragm was observed more often in penetrating trauma (83.3%) than in blunt trauma (17.7%). CONCLUSIONKnowledge of the mechanism of injury and familiarity with all CT signs of diaphragmatic injury are necessary to avoid a missed diagnosis because there is variability in the overall occurrence of these signs, with significant differences between blunt and penetrating trauma.

Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution

“…Table 4 summarizes the most recent TDI studies from different countries [1,3,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]. However, we may underestimate the incidence of TDI as the majority of mild (missed) or severe (died before diagnosis) lesions can be difficult to diagnose or because of the unavailability of routine postmortem examination in the state of Qatar.…”

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

“…[14] In addition, it has been reported that this sign is specific for blunt traumas rather than penetrating traumas. [2,3] A good agreement was found between CT signs and operative findings in all cases with a clearly visualized defect. A diaphragmatic injury extending to both sides of diaphragm was detected (contiguous injury sign) in seventeen patients with a diaphragmatic defect that was later repaired.…”

“…The sensitivity and specificity of CT for the diagnosis of diaphragmatic rupture are 61% to 87% and 72% to 100%, respectively. [3] Previous studies have reported various CT signs facilitating the diagnosis of diaphragmatic injuries. 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.…”

“…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.…”

“…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.…”