대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Courtesy

Chung-Ang University Hospital

Imaging Findings

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

Discussion

Operative Findings
Transabdominal approach

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

Reference

Operative Findings
Transabdominal approach

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

Keywords

Diaphragm,