The “Dependent Viscera” Sign in CT Diagnosis of Blunt  Traumatic Diaphragmatic Rupture

Bergin, Diane; Ennis, Rachel; Keogh, Ciarán; Fenlon, Helen M.; Murray, John

doi:10.2214/ajr.177.5.1771137

Cited by 150 publications

(101 citation statements)

References 21 publications

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“…In this way, rupture with visceral herniation can be diagnosed from axial CT images without directly imaging the diaphragm rent or edges of the tear. This sign was initially described by Bergin et al [22] in ten patients. The dependent viscera sign was seen on CT in 100% of patients with left-sided and 83% of patients with right-sided rupture.…”

Section: Blunt Traumamentioning

confidence: 69%

“…Admission radiographs are diagnostic in 27-62% of patients with left-sided and in 18-33% of cases with right-sided injuries [1,17,26,35,36]. Chest radiographs are suggestive but not diagnostic in another 18% of cases [22,33]. Serial chest radiographs are often useful.…”

Section: Chest Radiographymentioning

confidence: 99%

“…The dependent viscera sign was seen on CT in 100% of patients with left-sided and 83% of patients with right-sided rupture. Detection of diaphragmatic rupture was 90% using the dependent viscera sign with complete interobserver agreement [22]. A study performed by Nchimi et al [42] assessed CT findings in 179 blunt trauma patients, including 11 with left-sided and five with right-sided diaphragm rupture.…”

Section: Blunt Traumamentioning

confidence: 99%

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Imaging hemidiaphragmatic injury

Shanmuganagthan

2007

Eur Radiol

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Section: Blunt Traumamentioning

confidence: 69%

Section: Chest Radiographymentioning

confidence: 99%

Section: Blunt Traumamentioning

confidence: 99%

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Imaging hemidiaphragmatic injury

Shanmuganagthan

2007

Eur Radiol

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“…Spiral BT ile koronal ve sagittal görüntülerde diyafragma kontur düzensizliklerinin elde edilmesi hem subakut, hem de gecikmiş hastalarda diafragmatik yırtık-ları değerlendirmede en önemli yöntemdir. BT de, sağda karaciğerin kostaların posterioru ile bitişik olması, solda mide ve barsakların kotların posterioru ile temas etmesi (bağımlı organ işa-reti bulgusu), diyafragma devamsızlılığı, batıniçi organların toraksa herniasyonu ve organların defektte fokal sıkışması (yaka işareti bulgusu) diyafragma rüptüründe tespit edilen bulgulardır [6]. MRG ile karşılaştırıldığında, BT akut travma durumlarında daha kolay uygulanabilir ve akut künt travmalı hastaların incelemesinde daha yaygın bir şekilde kullanılır.…”

Section: Discussionunclassified

Confirmation of the Contribution of Radiological Imaging Methods in Diaphragmatic Pathologies

2016

Ann Clin Anal Med

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ÖzetAmaç: Bu çalışmada kliniğimizde çeşitli diyafragma patolojileri nedeniyle operasyon uygulanan hastalarda klinik bulguların, radyolojik yöntemlerin incelenmesi ve postoperatif sonuçların gözden geçirilmesi amaçlandı. Gereç ve Yöntem: Ocak 2007 -Haziran 2014 tarihleri arasında benign diyafragma patolojileri nedeniyle opere edilen 35 hasta retrospektif olarak incelendi. Hastalar preoperatif dönemde öncelikle lateral ve posteroanterior akciğer grafisi ile değerlendirildi. Gerekli görüldüğünde uygulanan diğer inceleme yöntem-leri ise bilgisayarlı tomografi, ultrasonografi ve manyetik rezonansdı. Hastalar; 10'u (%28,6) konjenital diyafragma hernisi, 16'sı (%45,7) travmatik diyafragma yaralanması ve 9'u (%25,7) diyafragma evantrasyonu olmak üze-re 3 gruba ayrıldı. Bulgular: Hastaların yaş ortalamaları 40,9±13,8 (14 -66 yaş arası) olup, 24'ü erkek, 11'i (%) kadındı. Altı hastaya (%17,1) acil şartlar-da torakotomi uygulandı, diğer hastalar elektif şartlarda değerlendirildikten sonra operasyona alındı. Hiçbir hastada defekt onarımında yama kullanımı-na gerek duyulmadı. Bilgisayarlı tomografi çekilen 27 hastadan 13'inde, ultrasonografi yapılan 22 hastadan 14'ünde ve manyetik rezonans istenen 18 hastadan üçünde tanı saptanamadı. Gruplar incelendiğinde; konjenital diyafragma herni teşhisinde manyetik rezonans, diyafragma evantrasyonunda ultrasonografi ve travmatik diyafragma laserasyonunda bilgisayarlı tomografi, patolojiyi daha yüksek oranda doğru tahmin etti. Üç hastada (%8,5) post operatif kanama nedeniyle retorakotomi uygulandı. Kesici alet yaralanması sonrası diyafragma, akciğer ve dalakta laserayon nedeniyle acil torakotomi ile opere edilen bir hasta erken dönemde kaybedildi (operatif mortalite %2,9). Tartışma: Radyolojik incelemelerdeki tüm gelişmelere rağmen diyafragma patolojisi düşünülen olgularda radyolojik yöntemlerin tanısal verimliliği istenen ölçülerde olamamaktadır. Bu çalışmadaki, cerrahi ile doğrulanan verilerde, MRI'ın diğer yöntemlere göre daha değerli sonuçlar verdiği izlenmiştir. Bu açıdan klinik ve radyolojik verilerin bir bütün olarak değerlendiril-mesi gerektiği kanısındayız. Anahtar KelimelerDiyafragma; Herni; Travmatik; Evantrasyon Abstract Aim: The aim of the present study was to review clinical findings, radiological methods, and postoperative outcomes in patients who underwent an operation at our clinic due to diaphragmatic hernia. Material and Method: The medical records of 35 patients, who were operated on due to benign diaphragmatic hernia between January 2007 and June 2014, were retrospectively reviewed. The patients had been particularly evaluated using lateral and posteroanterior chest radiographies in the preoperative period. Other imaging modalities that were employed when required were computerized tomography, ultrasonography, and magnetic resonance imaging. The patients were divided into three groups: 10 (28.6%) had congenital diaphragmatic hernia, 16 (45.7%) had traumatic diaphragmatic hernia, and 9 (25.7%) had diaphragmatic eventration. Results: The mean age of the patients was 4...

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“…With intra-thoracic herniation of abdominal contents, 'collar' sign which is waist like constriction of bowel, and/or 'dependent viscera' sign which refers to contact between stomach or bowel with posterior left ribs or contact between upper third of the liver with posterior right ribs may be observed 11 .The sensitivity of 'dependent viscera' sign in a series of 28 patients with acute BTDR was reported to be 90% overall; 100% in left sided diaphragmatic rupture 10 . In a report 12 of seven patients with BTDR diagnosed by ultrasound, the direct sonographic features were disrupted diaphragm in four patients, non-visualized diaphragm in three; floating diaphragm in two and herniation of liver or bowel loops through the diaphragmatic defect in three patients.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of blunt traumatic diaphragmatic hernia: A case report

Kidmas¹,

Iya²,

Isamade³

et al. 2006

Nigerian Journal of Surgical Research

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Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in polytraumatized patients. Diagnosis is often difficult resulting in delayed presentation and increased morbidity. We report a case of blunt traumatic diaphragmatic hernia in a 39-year-old man presenting 10 years after the initial abdomino-thoracic injury sustained in a road traffic accident. He had herniation of the spleen and stomach. Through a left thoracotomy, the herniated organs were reduced and diaphragmatic defect closed with interrupted nylon sutures. A high index of suspicion would minimize the morbidity and mortality associated with delayed diagnosis.

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The “Dependent Viscera” Sign in CT Diagnosis of Blunt Traumatic Diaphragmatic Rupture

Abstract: The dependent viscera sign increases the detection at CT of acute diaphragmatic rupture after blunt trauma.

Cited by 150 publications

References 21 publications

Imaging hemidiaphragmatic injury

Imaging hemidiaphragmatic injury

Confirmation of the Contribution of Radiological Imaging Methods in Diaphragmatic Pathologies

Delayed presentation of blunt traumatic diaphragmatic hernia: A case report

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