Skip to main content
SpringerLink
Log in

Traumatic Diaphragmatic Injuries

  • Chapter
  • First Online:
Emergency Radiology of the Chest and Cardiovascular System

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 1449 Accesses

Abstract

Diaphragmatic injuries are uncommon injuries in the chest, thus they can easily be missed by the radiologist and surgeon. Therefore, a high index of suspicion is important for an early diagnosis and to avoid any complications. Multidetector computed tomography is the modality of choice for the diaphragmatic injuries. On MDCT, there are direct and indirect signs of diaphragmatic injuries. In this chapter we discuss the findings associated with blunt as well as penetrating diaphragmatic injuries with an emphasis on the role of the radiologist in making the diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Barbiera F, Nicastro N, Finazzo M, Lo Casto A, Runza G, Bartolotta TV, Midiri M (2003) The role of MRI in traumatic rupture of the diaphragm. Our experience in three cases and review of the literature. Radiol Med 105(3):188–194

    PubMed  Google Scholar 

  • Bergin D, Ennis R, Keogh C, Fenlon HM, Murray JG (2001) The “dependent viscera” sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol 177(5):1137–1140

    Article  CAS  PubMed  Google Scholar 

  • Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K (2004) Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Am J Emerg Med 22(7):601–604

    Article  PubMed  Google Scholar 

  • Bodanapally UK, Shanmuganathan K, Mirvis SE, Sliker CW, Fleiter TR, Sarada K, Miller LA, Stein DM, Alexander M (2009) MDCT diagnosis of penetrating diaphragm injury. Eur Radiol 19(8):1875–1881

    Article  PubMed  Google Scholar 

  • Cantwell CP (2006) The dependent viscera sign. Radiology 238(2):752–753

    Article  PubMed  Google Scholar 

  • Chen HW, Wong YC, Wang LJ, Fu CJ, Fang JF, Lin BC (2010) Computed tomography in left-sided and right-sided blunt diaphragmatic rupture: experience with 43 patients. Clin Radiol 65(3):206–212

    Article  PubMed  Google Scholar 

  • Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM (2010) Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma 68(3):721–733

    Article  PubMed  Google Scholar 

  • Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, Patton JH Jr, Schurr MJ, Pritchard FE (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221(6):744–753; discussion 753–745

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Desir A, Ghaye B (2012) CT of blunt diaphragmatic rupture. RadioGraphics 32(2):477–498

    Article  PubMed  Google Scholar 

  • Desser TS, Edwards B, Hunt S, Rosenberg J, Purtill MA, Jeffrey RB (2010) The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol 17(1):37–44

    Article  PubMed  Google Scholar 

  • Dreizin D, Bergquist PJ, Taner AT, Bodanapally UK, Tirada N, Munera F (2015) Evolving concepts in MDCT diagnosis of penetrating diaphragmatic injury. Emerg Radiol 22(2):149–156

    Article  PubMed  Google Scholar 

  • Fair KA, Gordon NT, Barbosa RR, Rowell SE, Watters JM, Schreiber MA (2015) Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg 209(5):864–868; discussion 868–869

    Article  PubMed  Google Scholar 

  • Gangahar R, Doshi D (2010) FAST scan in the diagnosis of acute diaphragmatic rupture. Am J Emerg Med 28(3):387.e381–383

    Article  Google Scholar 

  • Gao JM, Du DY, Li H, Liu CP, Liang SY, Xiao Q, Zhao SH, Yang J, Lin X (2015) Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: difference between penetrating and blunt injuries. Chin J Traumatol 18(1):21–26

    Article  PubMed  Google Scholar 

  • Gelman R, Mirvis SE, Gens D (1991) Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR Am J Roentgenol 156(1):51–57

    Article  CAS  PubMed  Google Scholar 

  • Guth AA, Pachter HL, Kim U (1995) Pitfalls in the diagnosis of blunt diaphragmatic injury. Am J Surg 170(1):5–9

    Article  CAS  PubMed  Google Scholar 

  • Hammer MM, Flagg E, Mellnick VM, Cummings KW, Bhalla S, Raptis CA (2014) Computed tomography of blunt and penetrating diaphragmatic injury: sensitivity and inter-observer agreement of CT Signs. Emerg Radiol 21(2):143–149

    Article  PubMed  Google Scholar 

  • Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS (2008) The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 85(3):1044–1048

    Article  PubMed  Google Scholar 

  • Iochum S, Ludig T, Walter F, Sebbag H, Grosdidier G, Blum AG (2002) Imaging of diaphragmatic injury: a diagnostic challenge? RadioGraphics 22(Suppl 1):S103–S116

    Article  PubMed  Google Scholar 

  • Killeen KL, Mirvis SE, Shanmuganathan K (1999) Helical CT of diaphragmatic rupture caused by blunt trauma. AJR Am J Roentgenol 173(6):1611–1616

    Article  CAS  PubMed  Google Scholar 

  • Kirkpatrick AW, Ball CG, Nicolaou S, Ledgerwood A, Lucas CE (2006) Ultrasound detection of right-sided diaphragmatic injury; the “liver sliding” sign. Am J Emerg Med 24(2):251–252

    Article  PubMed  Google Scholar 

  • Leung VA, Patlas MN, Reid S, Coates A, Nicolaou S (2015) Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre. Can Assoc Radiol J 66(4):310–317

    Article  PubMed  Google Scholar 

  • Magu S, Agarwal S, Singla S (2012) Computed tomography in the evaluation of diaphragmatic hernia following blunt trauma. Indian J Surg 74(4):288–293

    Article  PubMed  PubMed Central  Google Scholar 

  • Murray JG, Caoili E, Gruden JF, Evans SJ, Halvorsen RA Jr, Mackersie RC (1996) Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR Am J Roentgenol 166(5):1035–1039

    Article  CAS  PubMed  Google Scholar 

  • Nchimi A, Szapiro D, Ghaye B, Willems V, Khamis J, Haquet L, Noukoua C, Dondelinger RF (2005) Helical CT of blunt diaphragmatic rupture. AJR Am J Roentgenol 184(1):24–30

    Article  PubMed  Google Scholar 

  • Panda A, Kumar A, Gamanagatti S, Patil A, Kumar S, Gupta A (2014) Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol 20(2):121–128

    PubMed  PubMed Central  Google Scholar 

  • Patlas MN, Leung VA, Romano L, Gagliardi N, Ponticiello G, Scaglione M (2015) Diaphragmatic injuries: why do we struggle to detect them? Radiol Med 120(1):12–20

    Article  PubMed  Google Scholar 

  • Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Buchler MW (1998) Missed diaphragmatic injuries and their long-term sequelae. J Trauma Inj Infect Crit Care 44(1):183–188

    Article  CAS  Google Scholar 

  • Rees O, Mirvis SE, Shanmuganathan K (2005) Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases. Clin Radiol 60(12):1280–1289

    Article  CAS  PubMed  Google Scholar 

  • Shanmuganathan K, Mirvis SE, White CS, Pomerantz SM (1996) MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients. AJR Am J Roentgenol 167(2):397–402

    Article  CAS  PubMed  Google Scholar 

  • Shatney CH, Sensaki K, Morgan L (2003) The natural history of stab wounds of the diaphragm: implications for a new management scheme for patients with penetrating thoracoabdominal trauma. Am Surg 69(6):508–513

    PubMed  Google Scholar 

  • Spann JC, Nwariaku FE, Wait M (1995) Evaluation of video-assisted thoracoscopic surgery in the diagnosis of diaphragmatic injuries. Am J Surg 170(6):628–630; discussion 630–621

    Article  CAS  PubMed  Google Scholar 

  • Standring S (2016) Diaphragm and phrenic nerves. Gray’s anatomy. S. Standring, Elsevier, UK, pp 970–975

    Google Scholar 

  • Thomas Sadler JL, Langman J, Sadler-Redmond SL, Sulik KK (2003) Langman’s medical embryology. Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  • Yucel M, Bas G, Kulali F, Unal E, Ozpek A, Basak F, Sisik A, Acar A, Alimoglu O (2015) Evaluation of diaphragm in penetrating left thoracoabdominal stab injuries: the role of multislice computed tomography. Injury 46(9):1734–1737

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Imaging Science, Division of Emergency Imaging, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA

    A. Olsen DO & R. Nicola MS DO

  2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kings highway Blvd, Campus Box 8131, St Louis, MO, 63110, USA

    C. Raptis MD

  3. Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, 237 Barton Street East, Hamilton, ON, Canada

    M. Patlas MD

Authors
  1. A. Olsen DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Nicola MS DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Raptis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Patlas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Patlas MD .

Editor information

Editors and Affiliations

  1. Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy

    Mariano Scaglione

  2. Ludwig-Maximilians-Universität München, München, Germany

    Ulrich Linsenmaier

  3. Vienna, Austria

    Gerd Schueller

  4. VU University Medical Center, Amsterdam, The Netherlands

    Ferco Berger

  5. University Hospital Munich, Munich, Germany

    Stefan Wirth

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Olsen, A., Nicola, R., Raptis, C., Patlas, M. (2016). Traumatic Diaphragmatic Injuries. In: Scaglione, M., Linsenmaier, U., Schueller, G., Berger, F., Wirth, S. (eds) Emergency Radiology of the Chest and Cardiovascular System. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2016_42

Download citation

  • DOI: https://doi.org/10.1007/174_2016_42

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42582-5

  • Online ISBN: 978-3-319-42584-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation