title: Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury.
abstract: OBJECTIVE
  We aimed to present the frequency of computed tomography (CT) signs of diaphragmatic rupture and the differences between blunt and penetrating trauma.
  
  
  METHODS
  The CT scans of 23 patients with surgically proven diaphragmatic tears (both blunt and penetrating) were retrospectively reviewed for previously described CT signs of diaphragmatic injuries. The overall frequency of CT signs was reported; frequency of signs in right- and left-sided injuries and blunt and penetrating trauma were separately tabulated and statistically compared.
  
  
  RESULTS
  The discontinuous diaphragm sign was the most common sign, observed in 95.7% of patients, followed by diaphragmatic thickening (69.6%). While the dependent viscera sign and collar sign were exclusively observed in blunt-trauma patients, organ herniation (P = 0.05) and dangling diaphragm (P = 0.0086) signs were observed significantly more often in blunt trauma than in penetrating trauma. Contiguous injury on either side of the diaphragm was observed more often in penetrating trauma (83.3%) than in blunt trauma (17.7%).
  
  
  CONCLUSIONS
  Knowledge of the mechanism of injury and familiarity with all CT signs of diaphragmatic injury are necessary to avoid a missed diagnosis because there is variability in the overall occurrence of these signs, with significant differences between blunt and penetrating trauma.
authors.affiliation: From the Departments of Radiology (A. Panda, A.K. dratinkumar@gmail.com, S.G., A. Patil) and Surgery (S.K., A.G.), All India Institute of Medical Sciences, Jai Prakash Narayana Apex Trauma Centre, New Delhi, India.
authors.forename: Ananya
authors.initials: A
authors.lastname: Panda
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamanagatti
authors.forename: Aruna
authors.initials: A
authors.lastname: Patil
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult