Uttam K. Bodanapally MD, Presenter: Nothing to Disclose

Kathirkamanathan Shanmuganathan MD, Abstract Co-Author: Nothing to Disclose

Stuart E. Mirvis MD, Abstract Co-Author: Nothing to Disclose

Clint W. Sliker MD, Abstract Co-Author: Nothing to Disclose

Lisa Anne Miller MD, Abstract Co-Author: Nothing to Disclose

Deborah Stein MD, PhD, Abstract Co-Author: Nothing to Disclose

This study was designed to determine the sensitivity, specificity, and accuracy of MDCT in detection of diaphragmatic injury following penetrating torso trauma.

Preoperative chest, abdominal and pelvic MDCT scans were reviewed from 136 patients who had experienced penetrating trauma to the torso (gunshot wounds, 76, stab wounds, 59, rebar impalement, 1) with wound tract extending in close proximity to the diaphragm. All patients in the study group underwent either video assisted thoracic surgery (VATS), thoracotomy, or laparotomy for thoracic or abdominal injuries. A single entry site was noted in 77 patients. CT images were reviewed retrospectively and independently by 6 radiologists unaware of surgical findings. Images were reviewed for the following MDCT findings, including: (1) discontinuity of diaphragm;(2) intrathoracic herniation of abdominal viscera;(3) “collar sign”;(4) “dependent viscera” sign;(5) contiguous injuries on either side of diaphragm; and (6) thickening of the diaphragm. MDCT findings were correlated with operative findings.

MDCT detected 41 of 47 diaphragmatic injuries (sensitivity 87.2%). The diaphragm was intact on MDCT in 71 of 98 (specificity 72.4%). Overall accuracy of MDCT was 77.2%. The positive predictive value of CT was 60% and negative predictive value was 92%.The most sensitive (81%) and specific (90%) MDCT finding in patients with a single entry site was contiguous injury on either side of diaphragm. Findings of discontinuity of diaphragm, herniation of abdominal viscera, “collar sign,” and “dependent viscera” sign were highly specific but had low sensitivities. There was no statistically significant inter-observer variability in reporting of the findings except for thickening of diaphragm.

MDCT is accurate in diagnosing diaphragm injuries after penetrating torso trauma. The most sensitive and specific MDCT finding for diaphragm injury in patients with single entry site was contiguous injury on either side of the diaphragm.

MDCT is accurate in diagnosing penetrating injuries to the diaphragm. The high negative predictive value helps to confidently exclude diaphragm injuries .

Bodanapally, U, Shanmuganathan, K, Mirvis, S, Sliker, C, Miller, L, Stein, D, MDCT Diagnosis of Penetrating Diaphragm Injury.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5011062.html