*50 year-old female with abdominal pain and shortness of breath.
What is the most likely diagnosis?
Answe
Answer: Traumatic diaphragmatic rupture
Case Discussion:
CT images showed appearance of liver and abdominal fat protruding through a defect (orange arrows) in the right hemidiaphragm, the collar sign (red arrows), the dependent viscera sign (yellow arrows) and renal localization of type 5 hydatid cyst (blue arrow).
Diaphragmatic hernias are divided into two main categories: congenital diaphragmatic defects and acquired diaphragmatic defects.
Congenital (rare)
• Bochdalek hernia: most common, located posteriorly and typically presents earlier (in infancy)
• Morgagni hernia: less common, smaller, located anteriorly and presents later
Acquired (common)
•traumatic diaphragmatic rupture
•hiatus hernia
•iatrogenic
CT
• Discontinuity of the hemidiaphragm can be seen with or without intrathoracic herniation of abdominal organs.
• The collar sign: collar-like appearance of herniated organs at the level of the diaphragm
• The dependent viscera sign: absence of interposition of lungs between the upper part of the abdominal organs and the chest wall and contact between the posterior ribs and the liver (right-sided injury) or stomach (left-sided injury).
• Segmental non-recognition of diaphragm
• Focal diaphragmatic thickening
• Thoracic fluid abutting the abdominal viscera
References:
1. Mullins ME, Stein J, Saini SS et-al. Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR Am J Roentgenol. 2001;177 (2): 363-6.
2. Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011;2 (3): 281-295.