Tuesday, September 25, 2012

Blunt Diaphragmatic Rupture

Traumatic blunt diaphragmatic rupture (BDR) is most commonly due to motor vehicle accidents (as was the case in the above patient). The left hemidiaphragm is more commonly injured than the right due to protective effects of the liver. Prompt diagnosis of BDR is important due to potentially life threatening complications if this injury is missed. Common signs indicating BDR on plain films and CT are as follows:

Radiographic signs:
  • loss of diaphragmatic continuity
  • intrathoracic herniation of a hollow viscus (stomach, bowel) or solid organ (liver, spleen)
  • visualization of nasogastric tube tip in thorax
  • collar sign - focal constriction of a herniating viscus at the site of diaphragmatic tear
CT signs:
  • discontinuity of diaphragm
  • collar sign (as above)
  • dependent viscera sign - herniated viscera is no longer freely suspended in the abdominal cavity and falls dependently (along the posterior ribs)

Desir A and Ghaye B. CT of blunt diaphragmatic rupture. Radiographics 2012;32:477-98.
Iochum S, Ludig T, Walter F, et al. Imaging of diaphragmatic injury: a diagnostic challenge?. Radiographics 2002;22:S103-16.

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