The evaluation of multi-dedector computed tomography findings in diaphragmatic i̇njuries related to penetrating and blunt trauma

SUMMARY: Purpose: Traumatic diaphragmatic rupture is a diagnostic challange for both surgeons and radiologists and generally occurs secondary to blunt and penetrating trauma of thoracoabdominal region. Early recognition and surgical repair is vital. Nowadays, increasing traffic accident and the cross stab wounds, gunshot wounds lead to an increase in the incidence of diaphragmatic rupture. In this study, we aimed to define type of traumatic diaphragmatic rupture, organ herniation secondary to the diaphragmatic rupture and the diagnostic radiological signs by multislice computed tomography. Material and Methods: Fifty -six patients who anderwent surgical procedure due to blunt or penetrating trauma leading diaphragmatic rupture and visualized by 16- or 64- multidedector computed tomography at Radiology Department of Dicle University Medical Faculty between 2006-2012 were included to the study. The images of the patients were retrospectively evaluated by two experienced radiologists. Patients, age and gender, cause of injury (penetrating or blunt), injury site, accompanied by other organ injuries, secondary organ herniation were evaluated. We also investigated the incidence of radiological signs secondary todiaphragmatic rupture. Results: Forty five men (80,3%) and 11 women (19,7%) were included to the study. The mean age of patients was 33.9 ± 17.1 (4-84) years. 37 of the patients (66,1%)had penetrating and 19 (33,9%) had blunt trauma. Post-traumatic hemidiaphragm was in left 37 patients (66,1%) and the right side in 19 patients (33,9%). All of the patients had accompanying organ injuries, most common lung (51,7%), and spleen (37,5%) injuries. 25 (44,6%) patients had concomitant organ herniation, in the order of the colon (60%), the stomach (48%). The most common radiological findings were ?Directly visualization of injury? (53,6%) and ? herniation of abdominal organs ? (44,6%) and ? diaphragmatic thickening ? (39,3%). In comparison of the left and right hemidiaphragm injuries in blunt and penetrating trauma, the radiological signs suggestive of diaphragmatic rupture were more frequent on the left side. Conclusion: The radiologist should be familiar with radiological signs of diaphragmatic rupture. Findings suggestive of diaphragmatic rupture must be carefully evaluated in patients with blunt or penetrating thoracoabdominal truma and the surgeon should be informed. Keywords: Multi-slice computed tomography, Trauma, Diaphragmatic rupture, Radiological signs.