title: The Role of Computed Tomography in the Diagnostics of Diaphragmatic Injury After Blunt Thoraco-Abdominal Trauma.
abstract: BACKGROUND
  Diaphragmatic injuries occur in 0.8-8% of patients with blunt trauma. The clinical diagnosis of diaphragmatic rupture is difficult and may be overshadowed by associated injuries. Diaphragmatic rupture does not resolve spontaneously and may cause life-threatening complications. The aim of this study was to present radiological findings in patients with diaphragmatic injury.
  
  
  METHODS
  The analysis of computed tomography examinations performed between 2007 and 2012 revealed 200 patients after blunt thoraco-abdominal trauma. Diaphragmatic rupture was diagnosed in 13 patients. Twelve of these patients had suffered traumatic injuries and underwent a surgical procedure that confirmed the rupture of the diaphragm. Most of diaphragmatic ruptures were left-sided (10) while only 2 of them were right-sided. In addition to those 12 patients there, another patient was admitted to the emergency department with left-sided abdominal and chest pain. That patient had undergone a blunt thoracoabdominal trauma 5 years earlier and complained of recurring pain. During surgery there was only partial relaxation of the diaphragm, without rupture. The most important signs of the diaphragmatic rupture in computed tomography include: segmental discontinuity of the diaphragm with herniation through the rupture, dependent viscera sign, collar sign and other signs (sinus cut-off sign, hump sign, band sign).
  
  
  RESULTS
  In our study blunt diaphragmatic rupture occurred in 6% of cases as confirmed intraoperatively. In all patients, coronal and sagittal reformatted images showed herniation through the diaphragmatic rupture. In left-sided ruptures, herniation was accompanied by segmental discontinuity of the diaphragm and collar sign. In right-sided ruptures, predominance of hump sign and band sign was observed. Other signs were less common.
  
  
  CONCLUSIONS
  The knowledge of the CT findings suggesting diaphragmatic rupture improves the detection of injuries in thoraco-abdominal trauma patients.
authors.affiliation: Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Gmachowska
authors.affiliation: Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland; 2 Department of Clinical Radiology, Medical University of Warsaw, Poland.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Pacho
authors.affiliation: Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Anysz-Grodzicka
authors.affiliation: Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland; 2 Department of Clinical Radiology, Medical University of Warsaw, Poland.
authors.forename: Leopold
authors.initials: L
authors.lastname: Bakoń
authors.affiliation: Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland; 2 Department of Clinical Radiology, Medical University of Warsaw, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Gorycka
authors.affiliation: Department of General and Thoracic Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wawrzyniec
authors.initials: W
authors.lastname: Jakuczun
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Patkowski
keywords: Diaphragm; Hernia, Diaphragmatic, Traumatic; Wounds, Nonpenetrating