Imaging of Diaphragm Injuries

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Anatomy

The diaphragm is a dome-shaped musculoskeletal structure that partitions the thoracic and abdominal cavities, and serves as the primary muscle of respiration [4]. It can be divided into several fibromuscular components that converge onto a central tendon. The anterior part attaches to the posterior margins of the lower sternum and xiphoid process. The lateral, or costal, parts attach to the inner margins of the sixth through twelfth ribs. Finally, the posterior lumbar part attaches to the

Location and mechanism of diaphragm injury

The left hemidiaphragm is injured in 50% to 88% of patients who have BDR, whereas right-sided injuries are less frequent and occur in 12% to 40% of cases [1], [3], [8], [11], [23], [24], [25], [26], [27]. In adults, bilateral and central tendon injuries are uncommon and are observed in only 2% to 6% of patients who present with BDR [3], [5], [8], [11], [27]. Children manifest an approximately even rate of right- and left-sided injuries that may be due to the increased mobility of the liver that

Clinical diagnosis

Clinical diagnosis of acute diaphragm injury can be challenging. Symptoms may be nonspecific and include dyspnea, chest pain, shoulder pain, and cyanosis [4], [5]. Typically, symptoms are secondary to visceral herniation through the diaphragm defect [5]. Bowel sounds over the hemithorax are suggestive, although other physical findings, such as decreased or absent breath sounds, contralateral mediastinal shift, abdominal tenderness, and guarding, are nonspecific and are obscured easily by signs

Imaging diagnosis

Historically, the imaging diagnosis of diaphragm injury has proven difficult. Similar to the clinical setting, imaging signs may be subtle and easily overlooked in the face of other more obvious injuries.

Summary

Because of potentially devastating delayed complications, early diagnosis of diaphragm injuries should be an important goal for radiologists who are involved in the care of patients who have experienced trauma. Despite the increasing availability of MR imaging and advancing videoscopic techniques, routine chest radiography and helical thoracoabdominal CT usually lead to the correct diagnosis, as long as the radiologist maintains a high index of suspicion and recognizes the subtle signs of

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