Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(03): 226-232
DOI: 10.4103/0971-3026.161433
Chest Radiology

Blunt traumatic diaphragmatic hernia: Pictorial review of CT signs

Ravinder Kaur
Department of Radiodiagnosis, GMCH, Chandigarh, India
,
Anuj Prabhakar
Department of Radiodiagnosis, PGIMER, Chandigarh, India
,
Suman Kochhar
Department of Radiodiagnosis, PGIMER, Chandigarh, India
,
Usha Dalal
Department of General Surgery, GMCH, Chandigarh, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. Although many imaging techniques have proven useful for the diagnosis of blunt diaphragmatic rupture, multidetector CT (MDCT) is considered to be the reference standard for the diagnosis of diaphragmatic injury. Numerous CT signs indicating blunt diaphragmatic rupture have been described in literature with variable significance. Accurate diagnosis depends upon the analysis of all the signs rather than a single sign; however, the presence of blunt diaphragmatic rupture should be considered in the presence of any of the described signs. We present a pictorial review of various CT signs used to diagnose blunt diaphragmatic injury. Multiplanar reconstruction is very useful; however, predominantly axial sections have been described in this pictorial review as the images shown are from dual-slice CT.

Keywords

Computed tomography - diaphragm - hernia - injury - trauma


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A. Traumatic diaphragmatic injury: A review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol 2014;20:121-8.
  • 2 Nchimi A, Szapiro D, Ghaye B, Willems V, Khamis J, Haquet L, et al. Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol 2005;184:24-30.
  • 3 Chen HW, Wong YC, Wang LJ, Fu CJ, Fang JF, Lin BC. Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: Experience with 43 patients. Clin Radiol 2010;65:206-12.
  • 4 Murray JG, Caoili E, Gruden JF, Evans SJ, Halvorsen RA Jr, Mackersie RC. Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol 1996;166:1035-9.
  • 5 Killeen KL, Mirvis SE, Shanmuganathan K. Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol 1999;173:1611-6.
  • 6 Bodanapally UK, Shanmuganathan K, Mirvis SE, Sliker CW, Fleiter TR, Sarada K, et al. MDCT diagnosis of penetrating diaphragm injury. Eur Radiol 2009;19:1875-81.
  • 7 Chavhan GB, Babyn PS, Cohen RA, Langer JC. Multimodality imaging of the pediatric diaphragm: Anatomy and pathologic conditions. Radiographics 2010;30:1797-817.
  • 8 Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: Anatomy and function. Radiographics 2012;32:E51-70.
  • 9 Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Büchler MW. Missed diaphragmatic injuries and their long-term sequelae. J Trauma 1998;44:183-8.
  • 10 Mihos P, Potaris K, Gakidis J, Paraskevopoulos J, Varvatsoulis P, Gougoutas B, et al. Traumatic rupture of the diaphragm: Experience with 65 patients. Injury 2003;34:169-72.
  • 11 Shanmuganathan K, Killeen K, Mirvis SE, White CS. Imaging of diaphragmatic injuries. J Thorac Imaging 2000;15:104-11.
  • 12 Koplewitz BZ, Ramos C, Manson DE, Babyn PS, Ein SH. Traumatic diaphragmatic injuries in infants and children: Imaging findings. Pediatr Radiol 2000;30:471-9.
  • 13 Brandt ML, Luks FI, Spigland NA, DiLorenzo M, Laberge JM, Ouimet A. Diaphragmatic injury in children. J Trauma 1992;32:298-301.
  • 14 Rodriguez-Morales G, Rodriguez A, Shatney CH. Acute rupture of the diaphragm in blunt trauma: Analysis of 60 patients. J Trauma 1986;26:438-44.
  • 15 Stark P, Jacobson F. Radiology of thoracic trauma. Curr Opin Radiol 1992;4:87-93.
  • 16 Sliker CW. Imaging of diaphragm injuries. Radiol Clin North Am 2006;44:199-211, vii.
  • 17 Desir A, Ghaye B. CT of blunt diaphragmatic rupture. Radiographics 2012;32:477-98.
  • 18 Carter BN, Giuseffi J, Felson B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther 1951;65:56-72.
  • 19 Desser TS, Edwards B, Hunt S, Rosenberg J, Purtill MA, Jeffrey RB. The dangling diaphragm sign: Sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol 2010;17:37-44.
  • 20 Larici AR, Gotway MB, Litt HI, Reddy GP, Webb WR, Gotway CA, et al. Helical CT with sagittal and coronal reconstructions: Accuracy for detection of diaphragmatic injury. AJR Am J Roentgenol 2002;179:451-7.
  • 21 Shanmuganathan K, Mirvis SE, White CS, Pomerantz SM. MR imaging evaluation of hemidiaphragms in acute blunt trauma: Experience with 16 patients. AJR Am J Roentgenol 1996;167: 397-402.
  • 22 Gerscovich EO, Cronan M, McGahan JP, Jain K, Jones CD, McDonald C. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20:597-604.