Discontinuity of hemidiaphragm with focal defect (segmental diaphragmatic defect)













IMAGING
General Features
CT Findings
• Multiple different direct and indirect signs of diaphragmatic injury, each with variable sensitivity and specificity
Discontinuity of hemidiaphragm with focal defect (segmental diaphragmatic defect)
Dangling diaphragm sign: Free edge of torn diaphragm curls inward on axial images rather than continuing its normal course parallel to chest wall
Absent diaphragm sign: Absence of diaphragm in expected location (without visualization of discrete tear)
Fallen or dependent viscus sign: Herniated viscus abuts posterior ribs and thoracic wall without intervening lung




Radiographic Findings
• Radiography
Radiographs are significantly less sensitive than CT for diaphragmatic injury, but may often be initial study performed

– Presence of lower thoracic soft tissue density mass or gas density suggesting herniated abdominal viscera
DIFFERENTIAL DIAGNOSIS
Congenital Diaphragmatic Hernias (Bochdalek or Morgagni Hernias)
CLINICAL ISSUES
Presentation
Natural History & Prognosis
• Prognosis
Delayed diagnosis and repair: Poor prognosis

– Initial diaphragmatic injury may be missed, even at surgery, due to attention to life-threatening injuries























