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Abdominal CT: diaphragmatic injuries

Evaluating bowel and mesenteric trauma

Describing diaphragmatic injuries

Blunt abdominal trauma can cause sudden increases in abdominal pressure that can injure the diaphragm and result in traumatic rupture.

Which side of the diaphragm is most often injured? The left side, as the liver plays a protective role on the right.

Diagnosing diaphragmatic injuries

Diaphragmatic rupture can be suspected when the stomach, small bowel, colon, or spleen herniate into the left chest as seen in this CT scout image.

Abdominal CT Trauma diaphragmatic injuries 1
Scout image

Carefully reviewing the coronal images is particularly helpful to identify the location of the defect and the structures that herniate through it.

Abdominal CT Trauma diaphragmatic injuries 2
Coronal abdominal image

Because the abdomen image and the chest image are acquired during slightly different phases in many trauma CT protocols, you might have to look at both series to get the full picture of the injury.

On this patient’s chest coronal image, most of the stomach herniated into the left chest through a large defect in the diaphragm. Notice the waist-like narrowing of the stomach as it passes through the defect.

Abdominal CT Trauma diaphragmatic injuries 3
Coronal chest image

Often, it is the lower chest that gives the first indication that there is a diaphragmatic injury. Normally, at the level of the heart, you expect to see the lower lungs on both sides. But in this case, we see the stomach laying in the left chest cavity, with food material and an air / fluid level, and a normal lung on the right. We can review the lung window to confirm these findings.

Abdominal CT Trauma diaphragmatic injuries 4

The scout image helps give us a roadmap of what is going on in this case, where the stomach herniated into the left chest. We can further evaluate the injury on the coronal CT image, which in this case captures the full injury. The stomach is clearly herniating into the left chest, compared to the normal right side protected by the liver.

Abdominal CT Trauma diaphragmatic injuries 5

Treating diaphragmatic injuries

The detailed information provided by CT imaging about the location of injury and herniated contents is essential for guiding the patient’s care, as surgical repair is usually needed for diaphragmatic injuries.


This is an edited excerpt from the Medmastery course Abdomen CT: Trauma by Michael P. Hartung, MD. Acknowledgement and attribution to Medmastery for providing course transcripts

References

Radiology Library: Abdominal Trauma. Solid organ injury

Abdominal CT interpretation

Assistant Professor of Abdominal Imaging and Intervention at the University of Wisconsin Madison School of Medicine and Public Health. Interests include resident and medical student education, incorporating the latest technology for teaching radiology. I am also active as a volunteer teleradiologist for hospitals in Peru and Kenya. | Medmastery | Radiopaedia | Website | Twitter | LinkedIn | Scopus 

Dr Adam Brown LITFL Author

MBChB (hons), BMedSci - University of Edinburgh. Living the good life in emergency medicine down under. Interested in medical imaging and physiology. Love hiking, cycling and the great outdoors.

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