imaging abdomen trauma diaphragmatic trauma part 7 dr ahmed esawy
TRANSCRIPT
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IMAGINGIN
DIAPHRAGMATIC INJURY Traumatic Diaphragmatic
Rupture TDR
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Up to 90% of traumatic diaphragmatic ruptures occur in young men after motor vehicle accidents the left hemidiaphragm injury more three-four times than injuries to the right side Most common hernaited organs Stomach <small and large bowel < spleen < liver
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Diaphragmatic Rupture Chest X-ray
-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 nasogastric tube above level of left diaphragm
-Elevation of the hemidiaphragm.
-Distortion or obliteration of the outline of the hemidiaphragm.
-Contralateral shift of the mediastinum.
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Nasogastric tube overlying chest on plain film ,in left thorax
DD :
Tip is still inside stomach : diaphragmatic rupture
Tip outside GIT : in bronchus or pleural space
Tube outside the patient
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Intrathoracic stomach herniation
With contralat.mediastinal shift
Intrathoracic colon herniation
With contralat. Mediastinnal shift
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Chest X-ray PA view
showing a heterogeneous
opacity in the left lower
zone
Barium meal examination of stomach and
intestine showing presence of loops of
intestine within the left hemithorax
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Right diaphragmatic rupture
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Partial herniation of stomach
into left chest
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TDR
Computed Tomography:
diaphragmatic defect or discontinuity of crus or dangling
diaphragm sign .
intrathoracic herniation of abdominal contents.
The collar sign, a waist like constriction of the herniating organ at
the site of the diaphragmatic tear.
The dependent viscera sign: supine at CT study
the herniated viscera (bowel or solid organs) are no longer
supported posteriorly by the injured diaphragm and fall to a
dependent position against posterior chest wall
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The collar sign dangling diaphragm sign .
Constriction of stomach
As it passes through
Diaphragmatic head
Collar sign
Torn free edge of left hemidiaphragm
dangling diaphragm sign .
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The dependent viscera sign
The stomach is lying adjacent to posterior ribs instead of within confines of
normal diaphragm
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Presence of bowel loops and kidney in the left hemithorax
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Herniation of stomach into chest
Discontinuity of left
Hemidiaphragm with
Stomach herniation into chest
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Normal patient Right hemidiaphragm tear
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Diaphragmatic defect or discontinuity
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Axial CT of the midthorax
Sagittal and coronal reformatted images
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Coronal reformatted CT image Coronal contrast material-enhanced fat-
suppressed fast gradient-echo MR
image
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Dependent sign
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Axial CT image Coronal reformatted CT image
Finding suggestive of diaphragmatic tear
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Sagittal single-shot fast spin-echo Coronal Gd fast gradient-echo
Post. diaphragm outlined by
hemoperitoneum+ pleural eff.
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Sagittal reformatted CT image Axial CT image
Effusion
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Traumatic Rupture of the Right Diaphragm duodenal contusion
diaphragmatic hematoma into the
posterior pararenal space (arrow)
posterior right rib fracture (arrow) at the
site of a diaphragmatic hematoma (black
arrowheads).
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DIFFERENTIAL DIAGNOSIS
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Bockdalek hernia absence of trauma morgagni hernia
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Eventration
Diaphragm retains its continuity and attachment to costal margin