Skip to main content
SpringerLink
Log in

Diaphragmatic injuries after blunt trauma: are they still a challenge?

Reviewing CT findings and integrated imaging

  • Review Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

Traumatic diaphragmatic rupture is a life-threatening injury that may occur in patients with blunt trauma. At present, supine chest radiographs is the initial, most commonly performed imaging test to evaluate a traumatic injury of the thorax. However, computed tomography (CT) is the imaging tool of choice, as it is the ‘gold standard’ for the detection of diaphragmatic injury after trauma. In particular, recent literature indicates that multidetector CT with multiplanar reformations has significantly improved in accuracy. Radiologists working in the emergency room should keep in mind the possibility of diaphragmatic injuries and should routinely integrate the axial images CT with multiplanar reformations in order to detect any potential, subtle or doubtful sign of incomplete diaphragmatic injury.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Scheme 1
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Meyers BF, McCabe CJ (1993) Traumatic diaphragmatic hernia: occult marker of serious injury. Ann Surg 218:783–790

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  3. Lee W, Chen R, Fang J et al (1994) Rupture of the diaphragm after blunt trauma. Eur J Surg 160:479–483

    PubMed  CAS  Google Scholar 

  4. Iochum S, Ludig T, Walter F et al (2002) Imaging of diaphragmatic injury: a diagnostic challenge. RadioGraphics 22:S113–S116

    Google Scholar 

  5. Shanmuganathan K, Killeen K, Mirvis SE et al (2000) Imaging of diaphragmatic injuries. J Thorac Imaging 15:104–111

    Article  PubMed  CAS  Google Scholar 

  6. Reber PU, Schimied B, Seiler CA et al (1998) Missed diaphragmatic injuried and their long-term sequelae. J Trauma 44:183–188

    Article  PubMed  CAS  Google Scholar 

  7. McElwee TB, Myers RT, Pennell TC (1984) Diaphragmatic rupture from blunt trauma. Am Surg 50:143–149

    PubMed  CAS  Google Scholar 

  8. Bosanquet D, Farbound A, Luckraz H (2009) A review diaphragmatic injury. Respir Med CME 2:1–6

    Article  Google Scholar 

  9. Mirvis SE, Shanmuganathan K (2007) Imaging hemidiaphragmatic injury. Eur Radiol 17:1411–1421

    Article  PubMed  Google Scholar 

  10. Bodanapally UK, Shanmuganathan K, Mirvis SE et al (2009) MDCT diagnosis of penetrating diaphragm injury. Eur Radiol 19:1875–1881

    Article  PubMed  Google Scholar 

  11. Sangster GP, Prieto Ventura V, Carbo A et al (2007) Diaphragmatic rupture: a frequently missed injury in blunt abdominal trauma patients. Emerg Radiol 13:225–230

    Article  PubMed  CAS  Google Scholar 

  12. Chughtai T, Ali S, Sharkey P et al (2009) Update on managing diaphragmatic rupture in blunt trauma: a review of 208 consecutive cases. Can J Surg 52(3):177–181

    PubMed  Google Scholar 

  13. Brown GL, Richardson JD (1985) Traumatic diaphragmatic hernia: a continuing challenge. Ann Thorac Surg 39:170–173

    Article  PubMed  CAS  Google Scholar 

  14. Nursal TZ, Ugurlu M, Kologlu M et al (2001) Traumatic diaphragmatic hernias: a report of 26 cases. Hernia 5:25–29

    Article  PubMed  CAS  Google Scholar 

  15. Boulanger BR, Milzman DP, Rosati C et al (1993) A comparison of right and left blunt traumatic diaphragmatic rupture. J Trauma 35:255–260

    Article  PubMed  CAS  Google Scholar 

  16. Scaglione M, Grassi R, Pinto A, Ragozzino A, Romano S et al (2000) Delayed presentation of traumatic left-sided diaphragmatic avulsion. A case report. Acta Radiol 41:165–166

    Article  PubMed  CAS  Google Scholar 

  17. Patselas TN, Callagher EG (2002) The diagnostic dilemma of diaphragm injury. Am Surg 68:633–639

    PubMed  Google Scholar 

  18. Eren S, Kantarci M, Okur A (2006) Imaging of diaphragmatic rupture after trauma. Clin Radiol 61:467–477

    Article  PubMed  CAS  Google Scholar 

  19. Mj S, Heiberg E, Durham RM et al (1995) The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture. Clin Radiol 51:27–30

    Google Scholar 

  20. Carter YM, Karmy-Jones RC, Stern EJ (2001) Delayed recognition of diaphragmatic rupture in a patient receiving mechanical ventilation. AJR 176:428

    PubMed  CAS  Google Scholar 

  21. Jg M, Canili E, Gruden JF et al (1996) Acute rupture of the diaphragm due to blunt trauma: diagnostic sensitivity and specificity of CT. AJR 166:1035–1039

    Google Scholar 

  22. Scaglione M, Pinto F, Grassi R et al (2000) CT assessment of blunt diaphragmatic injury. A retrospective study on 35 cases. Radiol Med 99:46–50

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  24. Bergin D, Ennis R, Keogh C et al (2001) The « dependent viscera » sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR 177:1137–1140

    PubMed  CAS  Google Scholar 

  25. Larici AR, Gotway MB, Litt HI et al (2002) Helical CT with sagittal and coronal reconstructions: accuracy for detection of diaphragmatic injury. AJR 179:451–457

    PubMed  Google Scholar 

  26. Nchimi A, Szapiro D, Ghaye B et al (2005) Helical CT of blunt diaphragmatic rupture. AJR 184:24–30

    PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  28. Desser TS, Edwards B, Hunt S et al (2010) The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol 17:37–44

    Article  PubMed  Google Scholar 

  29. Tonerini M (2010) Urgenze dell’esofago e del diaframma. Radiol Med 115(Suppl):75–80

    Google Scholar 

  30. Ptak T, Rhea JT, Novelline RA (2001) Experience with a continuous, single-pass whole body multi detector CT protocol for trauma: the three-minute multiple trauma CT scan. Emerg Radiol 8:250–256

    Article  Google Scholar 

  31. Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. RadioGraphics 20:1603–1616

    Article  Google Scholar 

  32. Hoffs WS, Holevar M, Nagy KK et al (2002) Practice management guidelines for the evaluation of blunt abdominal trauma. J Trauma 53:602–615

    Article  Google Scholar 

  33. Worthy SA, Kang EY, Hartman TE et al (1995) Diaphragmatic rupture: CT findings in 11 patients. Radiology 194:885–888

    PubMed  CAS  Google Scholar 

  34. Caskey CI, Zerhouni EA, Fishman EK et al (1989) Aging of diaphragm: a CT study. Radiology 171:385–389

    PubMed  CAS  Google Scholar 

  35. Sangster GP, Gonzalez-Beicos A, Carbo AI et al (2007) Blunt traumatic incurie of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computed tomography imaging findings. Emerg Radiol 14:297–310

    Article  PubMed  Google Scholar 

  36. Primack SL, Collins J (2002) Blunt nonaortic chest trauma: radiographic and CT findings. Emerg Radiol 9:5–12

    PubMed  Google Scholar 

  37. Leung JC, Nance ML, Schwab CW et al (1999) Thickening of the diaphragm: a new computed tomography sign of diaphragm injury. J Thorac Imaging 14:126–129

    Article  PubMed  CAS  Google Scholar 

  38. Shanmuganathan K, Mirvis SE, White CS et al (1996) MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients. AJR 167:397–402

    PubMed  CAS  Google Scholar 

  39. Allen TL, Cummins BF, Bonk RT et al (2005) Computed tomography without oral contrast solution for blunt diaphragmatic injuries in abdominal trauma. AJ Emerg Med 23:253–258

    Article  Google Scholar 

  40. Kim HH, Shin YR, Kim KJ et al (1997) Blunt traumatic rupture of the diaphragm: sonography diagnosis. J Ultrasound Med 16:593–598

    PubMed  CAS  Google Scholar 

  41. Hanna WC, Ferri LE, Fata P et al (2008) The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 85:1044–1048

    Article  PubMed  Google Scholar 

  42. Baldassarre E, Valenti G, Gambino M et al (2007) The role of laparoscopy in the diagnosis and the treatment of missed diaphragmatic hernia after penetrating trauma. J Laparoendosc Adv Surg Tech A 17(3):302–306

    Article  PubMed  Google Scholar 

  43. Mintz Y, Easter DW, Izhar U et al (2007) Minimally invasive procedures for diagnosis of traumatic right diaphragmatic tears: a method for correct diagnosis in selected patients. Am Surg 73:388–392

    PubMed  Google Scholar 

  44. Bergeron E, Clas D, Ratte S et al (2002) Impact of deferred treatment of blunt diaphragmatic rupture: a 15-year experience in six trauma centers in Quebec. J Trauma 52(4):633–640

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Pineta Grande Medical Center, Via Domiziana Km. 30, Castel Volturno, 81030, Italy

    Giorgio Bocchini, Franco Guida, Giacomo Sica, Umberto Codella & Mariano Scaglione

Authors
  1. Giorgio Bocchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Franco Guida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giacomo Sica
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Umberto Codella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mariano Scaglione
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariano Scaglione.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bocchini, G., Guida, F., Sica, G. et al. Diaphragmatic injuries after blunt trauma: are they still a challenge?. Emerg Radiol 19, 225–235 (2012). https://doi.org/10.1007/s10140-012-1025-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-012-1025-4

Keywords

Search

Navigation