Fresh rupture

  : about 7cm in diameter

  : posterolateral aspect of muscular portion

Herniated gastric fundus showed gangrenous change

Segmental resection of gastric fundus and repair of ruptured diaphragm

 

Imaging Findings of Diaphragmatic Injury

Chest Radiography

   Intrathoracic herniation of a hollow viscus (stomach, colon, small bowel) with or without focal constriction of    the viscus at the site of the tear (collar sign)

   Visualization of a nasogastric tube above the hemidiaphragm on the left side

CT

   Direct discontinuity of the hemidiaphragm

   Intrathoracic herniation of abdominal contents(left side :stomach and colon, right side: liver)

   Waistlike constriction of the herniating hollow viscus at the site of the diaphragmatic tear (collar sign)

   Dependent viscera sign

MR

   Abrupt disruption of the contour of the diaphragm and intrathoracic herniation of abdominal fat or viscera

Spontaneous rupture of the diaphragm

   Extremely rare (less than 1% of diaphragmatic rupture, less than 20 cases)

   Precipitating factor: athletics, weightlifting, dancing, parturition, violent emesis, coughing, defecation

   No pathognomic symptoms or signs →Delayed diagnosis

   Any thoracic mass with air-fluid level adjacent to the diaphragm on CXR

     : Association between onset of symptoms and instantaneous effort rising intra-abdomianl pressure

     : Multiplanar reformatted image

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