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Helical CT with Sagittal and Coronal Reconstructions: Accuracy for Detection of Diaphragmatic Injury

Anna R. Larici1, Michael B. Gotway2,3, Harold I. Litt2, Gautham P. Reddy2, W. Richard Webb2, Carol A. Gotway4, Samuel K. Dawn2,3, Shelley R. Marder2,3 and Maria Luigia Storto1

1 Department of Radiology, SS Annunziata Hospital, University of G. d'Annunzio, Via P. Valignani 1, Chieti 66100, Italy.
2 Department of Radiology, Rm. M-391, University of California, 505 Parnassus Ave., San Francisco, CA 94143-0628.
3 Department of Radiology, Thoracic Imaging Section, Rm. 1X 55A, Box 1325, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110.
4 Centers for Disease Control and Prevention, National Center for Environmental Health Centers for Disease Control and Prevention, MS E70, 1600 Clifton Rd., N.E., Atlanta, GA 30323.



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  		Fig. 1. —30-year-old man involved in motor vehicle collision. Axial CT image shows bowel (arrows) is resting against posterior ribs in left lower hemithorax. This finding represents "dependent viscera" sign. Rupture of left hemidiaphragm was surgically confirmed.

 


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  		Fig. 2. —17-year-old boy with right upper quadrant stab wound. Axial CT image reveals discontinuity of right hemidiaphragm (curved arrow), which is diagnostic of diaphragmatic injury. Active arterial extravasation of contrast material (straight arrow) indicates that injury is in close proximity to diaphragm.

 


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  		Fig. 3. —60-year-old man involved in motor vehicle collision. Axial CT image shows subjectively thickened right diaphragmatic crus (arrows), suggesting injury. Diaphragmatic rupture was confirmed at surgery.

 


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  		Fig. 4. —17-year-old girl with right upper quadrant gunshot injury. Axial CT image reveals subcutaneous emphysema in superficial tissues of right flank (straight arrow). Linear, irregular low-attenuation area in liver (curved arrow) is consistent with laceration from missile. Extrapolating missile trajectory indicates that projectile must have traversed diaphragm. Diaphragmatic injury was confirmed at surgery. Streak artifact emanates from bullet fragment in posterior soft tissues of thorax.

 


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  		Fig. 5A. —33-year-old man involved in motor vehicle collision. Axial CT image shows waistlike constriction of stomach (long arrows), suggesting herniation of stomach through injured diaphragm (short arrow).

 


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  		Fig. 5B. —33-year-old man involved in motor vehicle collision. Coronal reformatted CT image clearly shows herniation of stomach (long arrows) through diaphragmatic defect into left hemithorax; this finding represents collar sign. Diaphragm (short arrow) can be seen lateral to stomach.

 


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  		Fig. 6. —24-year-old man with right upper quadrant stab wound. Axial CT image reveals moderate-sized right pleural effusion (asterisk) but does not reveal direct evidence of diaphragmatic injury. Large effusion may obscure direct visualization of diaphragmatic injury that was proven at surgery.

 


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  		Fig. 7. —65-year-old man involved in motor vehicle collision. Axial CT image obtained with 1-mm collimation reveals evidence of splenic parenchymal injury (curved arrow). Curvilinear high-attenuation structure (straight arrows) posterior to spleen was thought to represent injured diaphragm, but no evidence of diaphragmatic injury was found at surgery.

 


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  		Fig. 8A. —30-year-old man involved in motor vehicle collision. Sagittal reformation reveals waistlike constriction (arrows) of dome of liver, raising possibility of right hemidiaphragm injury. No evidence of injury was found at surgery. This appearance may occur as artifact of reconstruction or of patient breathing during acquisition of imaging volume.

 


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  		Fig. 8B. —30-year-old man involved in motor vehicle collision. Coronal reformation again shows constriction (arrows) or collar sign.

 

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