Traumatic Diaphragmatic Rupture



Traumatic Diaphragmatic Rupture


Michael P. Federle, MD, FACR









(Left) Chest x-ray in a young man following a motor vehicle crash shows a pneumothorax, chest tube, and an NG tube that is curved up toward the chest image. (Right) Axial CT in the same patient shows all the typical signs of diaphragmatic injury, including the “fallen” viscus sign. The stomach image lies in the chest. Note that it has “fallen” medially and posteriorly to lie against the posteromedial chest wall. The stomach appears “pinched” image as it traverses the defect in the diaphragm (“collar” sign).






(Left) Coronal reformation of the CT in the same patient shows the herniated stomach image being “pinched” as it traverses the defect in the diaphragm image. (Right) Sagittal reformation of the CT sections in the same patient shows the herniated stomach image and its constriction image as it passes through the defect in the diaphragm.



TERMINOLOGY


Synonyms



  • Traumatic diaphragmatic hernia


Definitions



  • Diaphragmatic rupture ± herniation of abdominal contents into thorax


IMAGING


General Features



  • Best diagnostic clue



    • Discontinuity of hemidiaphragm with “fallen” or “dependent” viscus sign


  • Location



    • 90-98% occur on left side



      • Posterolateral part of diaphragm, medial to spleen


  • Size



    • Blunt trauma



      • Most tears are large (> 10 cm in length)


    • Penetrating trauma



      • Gun shot wounds (blast injuries) → large defects in diaphragm


      • Stab wounds → shorter lacerations



        • More likely to have delayed diagnosis


        • Initial short laceration may be overlooked; enlarges over time


  • Morphology



    • Curvilinear lacerations


  • Key concepts



    • Due to blunt and penetrating trauma


    • Occur in 1-5% of all blunt trauma victims


    • Accounts for 5% of all diaphragmatic hernias



      • Hiatal, Bochdalek, and Morgagni hernias are much more common


    • 90% of all strangulated diaphragmatic hernias are due to trauma


    • Herniated organs: Stomach > omentum, colon, small bowel, spleen, liver

Only gold members can continue reading. Log In or Register to continue

Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Traumatic Diaphragmatic Rupture
Premium Wordpress Themes by UFO Themes