Imaging of Diaphragmatic Injuries

Abstract

Multiple imaging modalities are available for the preoperative diagnosis of diaphragmatic injury. Chest radiographs are the initial and most commonly performed imaging study to evaluate the diaphragm after trauma. When chest radiography is indeterminate, spiral computed tomography (CT) with thin sections and reformatted images is the next study of choice, particularly because most hemodynamically stable patients with blunt diaphragm injury will require an admission CT examination to evaluate the extent and anatomical sites of coexisting thoracoabdominal injuries. Magnetic resonance imaging is used to evaluate the diaphragm for patients with clinical suspicion but an indeterminate diagnosis after chest radiography and spiral CT.

Imaging hemidiaphragmatic injury

“…Common associated intraabdominal injuries involve the spleen, in 27-60% of cases, and liver in 93% of patients with right and 24% of patients with left-sided diaphragm ruptures [1,7,15,16]. Other common concurrent extrathoracic and extraabdominal injuries include pelvic fractures (40-55%), long bone fractures (45-85%), and closed head injury (25-55%) [9,32].…”

“…Conventional CT has a variable sensitivity of 14-61% and specificity of 76-99% for diagnosing diaphragm rupture [6,13,32,33,35]. Limitations of conventional CT include difficulty in visualizing the entire dome-shaped diaphragm on axially oriented images, low-resolution sagittal and coronal reformatted images performed with 8-10 mm axial slice thickness, and difficulty differentiating the diaphragm from adjacent pulmonary pathology or normal soft tissue structures.…”

Computed Tomography in the Evaluation of Diaphragmatic Hernia following Blunt Trauma

“…The detection of traumatic diaphragmatic rupture in the acute setting is problematic because specific clinical signs are usually not evident [1]. Furthermore, the high frequency of associated injuries (52-100%) may distract from diaphragmatic injury [2,3].…”

Thoracotomy for Traumatic Diaphragmatic Hernia

“…However, in recent decades, with the development of digital and high-resolution equipment, many investigative techniques have been used and are helpful for diagnosis of TDH, including chest X-rays; high-resolution, multislice computed tomography (CT) scan; magnetic resonance imaging (MRI); laparoscopy; and thoracoscopy. Chest X-rays, despite technical limitations and low sensitivity, are still used as the first step for the diagnosis of TDH [6]. In our present paper, the diagnosis was made by chest X-ray in two patients.…”

“…CT is an important tool in the diagnosis of TDH. According to previous reports, CT is reported to have a sensitivity of 71 % (78 % for left-sided and 50 % for right-sided injuries), an accuracy of 88 % for the left and 70 % for the right, and a specificity of 100 % [6,7]. The best imaging method to diagnose TDH is spiral CT with sagittal and coronal reconstructed images [7,8].…”