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Helical CT of Blunt Diaphragmatic Rupture

Alain Nchimi1,2, David Szapiro1, Benoît Ghaye1, Valérie Willems1, Jamil Khamis2, Luc Haquet2, Charlemagne Noukoua1 and Robert F. Dondelinger1

1 Department of Medical Imaging, University Hospital Sart Tilman, B-4000 Liège, Belgium.
2 Department of Medical Imaging, Centre Hospitalier Chrétien, Les Cliniques St.-Joseph, Rue de Hesbaye, 75, B-4000 Liège, Belgium.



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  		Fig. 1. —32-year-old man who sustained blunt trauma to torso. Abdominal CT scan obtained after IV injection of contrast medium shows herniation of upper part of stomach into chest, in contact with posterior thoracic wall (arrow) and adjacent to pleural effusion (asterisk). Left hemidiaphragm is not visible above abdominal fat (arrowheads).

 


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  		Fig. 2. —43-year-old man who sustained abdominal blunt trauma. Abdominal CT scan obtained after IV injection of contrast medium shows diffuse thickening of right hemidiaphragm (arrows). This sign was only indication of right-sided diaphragmatic rupture, which was confirmed at surgery.

 


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  		Fig. 3A. —Abdominal CT scans obtained after IV injection of contrast medium in 32-year-old man admitted after frontal impact during car crash. Right hemidiaphragm is visualized over liver, thanks to fat interposition (asterisk).

 


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  		Fig. 3B. —Abdominal CT scans obtained after IV injection of contrast medium in 32-year-old man admitted after frontal impact during car crash. Image at level inferior to A shows lateral discontinuity of right hemidiaphragm (straight arrow), whereas anterior leaf is retracted and thickened (arrowheads). Associated constriction (curved arrow) of contused and partially herniated liver is present.

 


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  		Fig. 4. —36-year-old man after car crash. Abdominal CT scan obtained after IV injection of contrast medium shows representative pitfall of CT for diagnosis of blunt diaphragmatic rupture. Extensive splenic contusion and massive hemoperitoneum are evident. Left subphrenic hematoma (arrows) simulates diaphragmatic thickening. Linear extravasation of contrast material is seen in contact with diaphragm (arrowheads). This patient was diagnosed as having, or was suspected of having, left-sided blunt diaphragmatic rupture by all reviewers. At surgery, no diaphragmatic rupture was found.

 


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  		Fig. 5A. —Abdominal CT scans obtained after IV injection of contrast medium via right common femoral vein in 27-year-old man who sustained abdominal trauma during car crash. Image at level of celiac trunk shows crus of right hemidiaphragm in contact with aorta (white arrowheads), whereas posterior part is not visible (black arrowheads). Focal infarct of right kidney (asterisk) is also seen.

 


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  		Fig. 5B. —Abdominal CT scans obtained after IV injection of contrast medium via right common femoral vein in 27-year-old man who sustained abdominal trauma during car crash. Image at level of liver hilum shows hypoattenuated right diaphragmatic crus (arrows), hypoperfusion complex of spleen, hemoperitoneum, and focal infarct of right kidney (asterisk).

 


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  		Fig. 5C. —Abdominal CT scans obtained after IV injection of contrast medium via right common femoral vein in 27-year-old man who sustained abdominal trauma during car crash. Images at levels superior to B show progressively thickened but normally attenuated right hemidiaphragm (arrows).

 


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  		Fig. 5D. —Abdominal CT scans obtained after IV injection of contrast medium via right common femoral vein in 27-year-old man who sustained abdominal trauma during car crash. Images at levels superior to B show progressively thickened but normally attenuated right hemidiaphragm (arrows).

 


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  		Fig. 6A. —Axial CT scans obtained after IV contrast administration in 55-year-old man who sustained thoracoabdominal trauma during car crash. Image of posteromedial part of left hemidiaphragm shows defect (arrows).

 


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  		Fig. 6B. —Axial CT scans obtained after IV contrast administration in 55-year-old man who sustained thoracoabdominal trauma during car crash. Image at level superior to A displays fully continuous left hemidiaphragm. This patient illustrated another pitfall of CT for diagnosis of diaphragmatic rupture. Staff radiologists considered findings suggestive of left-sided blunt diaphragmatic rupture, whereas at surgery no diaphragmatic rupture was found.

 

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