Diagnostic and Interventional Radiology
Chest Imaging - Original Article

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

1.

From the Departments of Radiology All India Institute of Medical Sciences, Jai Prakash Narayana Apex Trauma Centre, New Delhi, India.

2.

From the Departments of Radiology, All India Institute of Medical Sciences, New Delhi, India

3.

From the Departments of Radiology and Surgery All India Institute of Medical Sciences, Jai Prakash Narayana Apex Trauma Centre, New Delhi, India.

Diagn Interv Radiol 2014; 20: 121-128
DOI: 10.5152/dir.2013.13248
Read: 761 Downloads: 437 Published: 03 September 2019

Abstract

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 METHODS: 
The 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. 

RESULTS: 

The 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%). 

CONCLUSION: 
Knowledge 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.

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