View
20
Download
6
Category
Preview:
Citation preview
IMAGINGIN
DIAPHRAGMATIC INJURY Traumatic Diaphragmatic
Rupture TDR
Up to 90% of traumatic diaphragmatic ruptures occur in young men after motor vehicle accidents the left hemidiaphragm injury more three-four times than injuries to the right side Most common hernaited organs Stomach <small and large bowel < spleen < liver
Diaphragmatic Rupture Chest X-ray
-Intrathoracic herniation of a hollow viscus (stomach, colon, small bowel) with or without focal constriction of the viscus at the site of the tear (collar sign) -Visualization of nasogastric tube above level of left diaphragm
-Elevation of the hemidiaphragm.
-Distortion or obliteration of the outline of the hemidiaphragm.
-Contralateral shift of the mediastinum.
Nasogastric tube overlying chest on plain film ,in left thorax
DD :
Tip is still inside stomach : diaphragmatic rupture
Tip outside GIT : in bronchus or pleural space
Tube outside the patient
Intrathoracic stomach herniation
With contralat.mediastinal shift
Intrathoracic colon herniation
With contralat. Mediastinnal shift
Chest X-ray PA view
showing a heterogeneous
opacity in the left lower
zone
Barium meal examination of stomach and
intestine showing presence of loops of
intestine within the left hemithorax
Right diaphragmatic rupture
Partial herniation of stomach
into left chest
TDR
Computed Tomography:
diaphragmatic defect or discontinuity of crus or dangling
diaphragm sign .
intrathoracic herniation of abdominal contents.
The collar sign, a waist like constriction of the herniating organ at
the site of the diaphragmatic tear.
The dependent viscera sign: supine at CT study
the herniated viscera (bowel or solid organs) are no longer
supported posteriorly by the injured diaphragm and fall to a
dependent position against posterior chest wall
The collar sign dangling diaphragm sign .
Constriction of stomach
As it passes through
Diaphragmatic head
Collar sign
Torn free edge of left hemidiaphragm
dangling diaphragm sign .
The dependent viscera sign
The stomach is lying adjacent to posterior ribs instead of within confines of
normal diaphragm
Presence of bowel loops and kidney in the left hemithorax
Herniation of stomach into chest
Discontinuity of left
Hemidiaphragm with
Stomach herniation into chest
Normal patient Right hemidiaphragm tear
Diaphragmatic defect or discontinuity
Axial CT of the midthorax
Sagittal and coronal reformatted images
Coronal reformatted CT image Coronal contrast material-enhanced fat-
suppressed fast gradient-echo MR
image
Dependent sign
Axial CT image Coronal reformatted CT image
Finding suggestive of diaphragmatic tear
Sagittal single-shot fast spin-echo Coronal Gd fast gradient-echo
Post. diaphragm outlined by
hemoperitoneum+ pleural eff.
Sagittal reformatted CT image Axial CT image
Effusion
Traumatic Rupture of the Right Diaphragm duodenal contusion
diaphragmatic hematoma into the
posterior pararenal space (arrow)
posterior right rib fracture (arrow) at the
site of a diaphragmatic hematoma (black
arrowheads).
DIFFERENTIAL DIAGNOSIS
Bockdalek hernia absence of trauma morgagni hernia
Eventration
Diaphragm retains its continuity and attachment to costal margin
Recommended