blunt abdominal trauma penetrating abdominal trauma fast abdominal ultrasound haemoperitoneum pneumoperitoneum american association of surgeon in trauma AAST SUBCAPSULAR HAEMATOMA PARENCHYMAL LACERATION include different cases for oral radiodiagnosis examination all over the world CT /MRI Plain X ray images DIAPHRAGMATIC INJURY DIAPHRAGMATIC RUPTURE DIAPHRAGMATIC DEFECT DEPENDENT VISCERA SIGN

1. I M AG I N G I N
DIAPHRAGMATIC INJURY
Traumatic Diaphragmatic
Rupture TDR

3. Up to 90% of traumatic diaphragmatic ruptures
occur in young men after motor vehicle accidents
the left hemidiaphragm injury more three-four
times than injuries to the right side
Most common hernaited organs
Stomach <small and large bowel < spleen < liver

4. Diaphragmatic Rupture Chest X-ray
-Intrathoracic herniation of a hollow viscus (stomach, colon,
small bowel) with or without focal constriction of the
viscus at the site of the tear (collar sign)
-Visualization of nasogastric tube above level of left diaphragm
-Elevation of the hemidiaphragm.
-Distortion or obliteration of the outline of the hemidiaphragm.
-Contralateral shift of the mediastinum.

5. Nasogastric tube overlying chest on plain film ,in left thorax
DD :
Tip is still inside stomach : diaphragmatic rupture
Tip outside GIT : in bronchus or pleural space
Tube outside the patient

6. Intrathoracic stomach herniation
With contralat.mediastinal shift
Intrathoracic colon herniation
With contralat. Mediastinnal shift

7. Chest X-ray PA view
showing a heterogeneous
opacity in the left lower
zone
Barium meal examination of stomach and
intestine showing presence of loops of
intestine within the left hemithorax

8. Right diaphragmatic rupture

9. Partial herniation of stomach
into left chest

10. TDR
Computed Tomography:
diaphragmatic defect or discontinuity of crus or dangling
diaphragm sign .
intrathoracic herniation of abdominal contents.
The collar sign, a waist like constriction of the herniating organ at
the site of the diaphragmatic tear.
The dependent viscera sign: supine at CT study
the herniated viscera (bowel or solid organs) are no longer
supported posteriorly by the injured diaphragm and fall to a
dependent position against posterior chest wall

11. The collar sign dangling diaphragm sign .
Constriction of stomach
As it passes through
Diaphragmatic head
Collar sign
Torn free edge of left hemidiaphragm
dangling diaphragm sign .

12. The dependent viscera sign
The stomach is lying adjacent to posterior ribs instead of within confines of
normal diaphragm

13. Presence of bowel loops and kidney in the left hemithorax

14. Herniation of stomach into chest
Discontinuity of left
Hemidiaphragm with
Stomach herniation into chest

15. Normal patient Right hemidiaphragm tear

16. Diaphragmatic defect or discontinuity

17. Axial CT of the midthorax
Sagittal and coronal reformatted images

18. Post contrast axial CT scan

19. Coronal reformatted CT image
Coronal contrast material-enhanced fat-
suppressed fast gradient-echo MR
image

20. Dependent sign

21. Axial CT image Coronal reformatted CT image
Finding suggestive of diaphragmatic tear

22. Sagittal single-shot fast spin-echo Coronal Gd fast gradient-echo
Post. diaphragm outlined by
hemoperitoneum+ pleural eff.

23. Sagittal reformatted CT imageAxial CT image
Effusion

24. Traumatic Rupture of the Right Diaphragm duodenal contusion
diaphragmatic hematoma into the
posterior pararenal space (arrow)
posterior right rib fracture (arrow) at the
site of a diaphragmatic hematoma (black
arrowheads).

25. DIFFERENTIAL DIAGNOSIS

26. Bockdalek hernia absence of trauma morgagni hernia

27. Eventration
Diaphragm retains its continuity and attachment to costal margin