Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
Clin Radiol. 2010 Mar;65(3):206-12. doi: 10.1016/j.crad.2009.11.005. Epub 2010 Jan 4.
To investigate differences in the radiographic signs for left and right-sided blunt diaphragmatic rupture (BDR) in order to provide guidance to avoid missing these injuries.
A retrospective review of the computed tomography (CT) examinations of 43 patients with BDR treated at our hospital between January 1995 and 2007 was undertaken. The presence of diaphragmatic discontinuity, diaphragmatic thickening, herniation of abdominal organs into the thoracic cavity, collar/hump sign, dependent viscera sign, abnormally elevated 4 cm or more above the dome of the other-sided hemi-diaphragm, and of associated injuries was recorded and their relationship to each other and to BDR diagnosis examined. A comparison between the use of axial and sagittal/coronal reconstruction images in diagnosis was also performed in 15 patients.
On axial imaging, left-sided diaphragmatic rupture occurred in 31 patients (72%) and right-sided in 12 (28%). Twenty-nine patients had associated injuries. More than 60% of the patients showed the "dependent viscera" sign, "abdominal organ herniation" sign, diaphragm thickening, or had a more than 4 cm elevation of one side of the diaphragm. "Diaphragmatic discontinuity" and "stomach herniation" were seen almost exclusively in left-sided rupture. Those with BDR and haemothorax had a significantly lower incidence of "diaphragm discontinuity" (p=0.034) than those without haemothorax. Sagittal/coronal reconstruction slightly increased the number of band signs, diaphragmatic discontinuities and diaphragmatic thickenings seen.
Of the CT signs examined in this study, when herniation of abdominal organs was used as a diagnostic marker, only a very small fraction of trauma patients identifiable by CT would be missed. Further, CT signs differ for left-sided and right-sided BDR, thus the possibility of BDR should be considered when any of the reported CT signs are present.
探讨左侧和右侧钝性膈肌破裂（BDR）的影像学征象差异，以指导避免漏诊这些损伤。
回顾性分析 1995 年 1 月至 2007 年我院收治的 43 例 BDR 患者的 CT 检查资料。记录膈中断、膈增厚、腹部脏器疝入胸腔、领/驼峰征、依赖脏器征、同侧半膈肌穹窿上方抬高 4cm 或以上、合并伤的存在，并分析其与 BDR 诊断的关系。还对 15 例患者轴位和矢状/冠状重建图像在诊断中的应用进行了比较。
在轴位成像上，左侧膈肌破裂 31 例（72%），右侧 12 例（28%）。29 例有合并伤。超过 60%的患者出现“依赖脏器”征、“腹部脏器疝入”征、膈增厚或一侧膈肌抬高超过 4cm。“膈中断”和“胃疝入”几乎仅见于左侧破裂。伴血胸的 BDR 患者膈中断的发生率明显低于无血胸的患者（p=0.034）。矢状/冠状重建略微增加了带征、膈中断和膈增厚的数量。
在本研究中检查的 CT 征象中，当腹部脏器疝入被用作诊断标志物时，仅极少数可通过 CT 识别的创伤患者会被漏诊。此外，左侧和右侧 BDR 的 CT 征象不同，因此当出现任何报告的 CT 征象时，都应考虑 BDR 的可能性。
