Blunt diaphragmatic lesions: Imaging findings and pitfalls

Abstract

Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.

Unravelling the Mysteries of Traumatic Diaphragmatic Injury: An Up-to-Date Review

“…Another direct sign of TDI is thickening caused by intramuscular hematoma and edema or retraction upon injury. 2,31 Some studies have concluded that this finding is a very sensitive sign for right blunt TDI. However, it is estimated that diaphragmatic thickening has a bilateral sensitivity of only 36% to 63% and a specificity of 58% to 77%.…”

Double traumatic diaphragmatic injury: A case report

“…Plain chest X-ray and FAST ultrasound, although represent the most accessible and first line imaging modality in the trauma patients, have a poor accuracy (nonspecific alterations in only 20%–50% of the patients - i.e. interruption of diaphragm silhouette, hemidiaphragm elevation, costo-phrenic sulcus obliteration or distorted diaphragmatic profile) [5,6]. The only direct sign is represented by the visualization of herniated bowels or the nasogastric tube into the thoracic cavity [5,6].…”

“…interruption of diaphragm silhouette, hemidiaphragm elevation, costo-phrenic sulcus obliteration or distorted diaphragmatic profile) [5,6]. The only direct sign is represented by the visualization of herniated bowels or the nasogastric tube into the thoracic cavity [5,6]. For this reason, whole-body contrast CT scan with multiplanar reconstructions is nowadays the imaging modality of choice.…”

“…For this reason, whole-body contrast CT scan with multiplanar reconstructions is nowadays the imaging modality of choice. Thanks to its high accuracy (60%–90% sensitivity and 70%–100% specificity) [5,6], it is able to directly detect diaphragmatic lesions, herniated bowels or indirect signs (i.e. “dangling diaphragm sign”, “collar sign” and “hump and band” sign) [6].…”

“…Thanks to its high accuracy (60%–90% sensitivity and 70%–100% specificity) [5,6], it is able to directly detect diaphragmatic lesions, herniated bowels or indirect signs (i.e. “dangling diaphragm sign”, “collar sign” and “hump and band” sign) [6]. When equivocal findings on imaging studies are present and conservative management (NOM) is not suitable, exploratory laparoscopy achieve 90–100% sensibility and specificity in detecting diaphragmatic injuries [1,5,7].…”