Multidetector-row CT of right hemidiaphragmatic rupture caused by blunt trauma: a review of 12 cases

Abstract

To determine the usefulness of multidetector-row CT (MDCT) with multiplanar reformatted (MPR) images in the sagittal and coronal plane in diagnosing acute right hemidiaphragmatic rupture. Twelve patients were identified who received chest and abdominal MDCT after major blunt trauma diagnosed with right diaphragmatic injury. Sagittal and coronal reformations were performed in all cases. The images were retrospectively reviewed by two experienced radiologists for signs of right diaphragm injury, such as direct diaphragm discontinuity, the "collar sign", the "dependent viscera sign", and intra-thoracic location of herniated abdominal contents. Of the 12 cases of right hemidiaphragm rupture, diaphragm discontinuity was seen in seven (58%) cases, the collar sign in five (42%), the dependent viscera sign in four (33%), and transdiaphragmatic herniation of the right colon and fat in another. Two variants of the collar sign were apparent on high-quality sagittal and coronal reformations. The first, termed the "hump sign", describes a rounded portion of liver herniating through the diaphragm forming a hump-shaped mass, and the second, termed the "band sign," is a linear lucency across the liver along the torn edges of the hemidiaphragm. The hump sign occurred in 10 (83%) patients and the band sign in four (33%). MDCT is very useful in the diagnosis of right hemidiaphragm injury caused by blunt trauma when sagittal and coronal reformatted images are obtained, and should allow more frequent preoperative diagnosis.