IS Case 402: Traumatic rupture of the right hemidiaphragm

Jeremy Sykes, MD

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-08-27

History

Patient is a 96-year-old male, status post motor vehicle collision.

Findings

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Diagnosis

Traumatic rupture of the right hemidiaphragm

Discussion

Traumatic herniation of abdominal contents through a tear or rupture of the hemidiaphragm may follow blunt or penetrating thoracoabdominal trauma. The left side is affected in more than 90% of cases because the liver dissipates the traumatic forces and usually protects the right hemidiaphragm from injury. The above case therefore represents the minority of diaphragmatic ruptures. On chest x-ray, the diagnosis may be suspected when the diaphragmatic contour is indistinct or when gas-filled loops of bowel or stomach are seen within the hemithorax following severe trauma. Early diagnosis may be difficult, as other injuries may obscure clinical and radiographic findings. Upper/lower GI or CT may demonstrate bowel or visceral organs herniating into the thorax through a constricting diaphragmatic defect ("collar" or "waist" sign). Sagittal and coronal CT reconstructions are often useful. Other findings include thickening or retraction of the diaphragm away from the injury, as well as contact between the posterior ribs and liver (right-sided injury) or stomach (left-sided injury), termed the "dependent viscera" sign.

References

  1. Brant WE, Helms CA, Klein J. Fundamentals of Diagnostic Radiology, 3rd Ed. Lippincott Williams & Wilkins, Philadelphia. 2006:550-552.
  2. Weissleder R, Wittenberg J, Harisinghani M, et al. Primer of Diagnostic Imaging, 4th Ed. Mosby Elsevier, Philadelphia. 2007:59-60.

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