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(Radiographics. 2002;22:S103-S116.)
© RSNA, 2002

MEDIASTINUM, CHEST WALL, AND DIAPHRAGM

Imaging of Diaphragmatic Injury: A Diagnostic Challenge?1

Sandrine Iochum, MD, Thomas Ludig, MD, Frédéric Walter, MD, Hugues Sebbag, MD, Gilles Grosdidier, MD and Alain G. Blum, MD

1 From the Department of Radiology "Imagerie Guilloz" (S.I., T.L., F.W., A.G.B.) and Department of Surgery (H.S., G.G.), Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035 Nancy, France. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 27, 2002; revision requested April 1; final revision received June 14; accepted June 19. Address correspondence to S.I. (e-mail: s.iochum@chu-nancy.fr).

Diaphragmatic injuries occur in 0.8%–8% of patients after blunt trauma. Although the diagnosis may be obvious at standard chest radiography or computed tomography (CT) in most situations, some more subtle signs require careful analysis of CT images and examination with magnetic resonance (MR) imaging in some specific situations. Each method of imaging evaluation has advantages and pitfalls according to the type of diaphragmatic rupture. MR imaging with breath-hold acquisition permits good visualization of diaphragmatic abnormalities, but this technique cannot be performed in emergency situations. Because of a dramatic reduction in motion and beam-hardening artifacts and significant improvement of spatial resolution, especially along the z axis, helical CT and multisection CT allow better demonstration of the most subtle signs, such as a focal indentation of the liver or a right-sided collar sign. In addition, helical CT and multisection CT are useful tools in the evaluation of patients with multiple traumatic injuries.

© RSNA, 2002

Index Terms: Diaphragm, injuries, 66.4124, 795.411 • Diaphragm, rupture, 66.4124, 795.411 • Trauma, 66.4124, 795.411






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