Discussion of Diaphragmatic rupture
- Traumatic diaphragmatic injuries occur in 0.8%–8% of patients who sustain blunt trauma.
- Up to 90% of diaphragmatic ruptures from blunt trauma occur in young men after motor vehicle accidents.
- Injuries to the left hemidiaphragm occur three times more frequently than injuries to the right side following blunt trauma, possibly due to a buffering effect of the liver on the right hemidiaphragm.
- Most ruptures are longer than 10 cm and occur at the posterolateral aspect of the hemidiaphragm between the lumbar and intercostal attachments and spread in a radial direction.
- If not made in the first 4 hours, the diagnosis may be delayed for months or years.
 Imaging Findings for Diaphragmatic rupture
 Plain film
- Specific diagnostic findings of diaphragmatic tears on chest radiographs include the following:
- 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 a nasogastric tube above the hemidiaphragm on the left side.
- Direct discontinuity of the hemidiaphragm
- Intrathoracic herniation of abdominal contents. The stomach and colon are the most common viscera to herniate on the left side and the liver is the most common viscus to herniate on the right side.
- The collar sign, a waistlike constriction of the herniating hollow viscus at the site of the diaphragmatic tear
- The dependent viscera sign. When a patient with a ruptured diaphragm lies supine at CT examination, the herniated viscera (bowel or solid organs) are no longer supported posteriorly by the injured diaphragm and fall to a dependent position against the posterior ribs.
 See Also
 External Links
 References for Diaphragmatic rupture
- Sandrine Iochum, Thomas Ludig, Frédéric Walter, Hugues Sebbag, Gilles Grosdidier, and Alain G. Blum. Imaging of Diaphragmatic Injury: A Diagnostic Challenge? RadioGraphics 2002 22: 103S-116S.