Vincent Andrew Leung MD, Presenter: Nothing to Disclose

Susan Reid MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Angela Coates MEd, Abstract Co-Author: Nothing to Disclose

Michael Nathan Patlas MD, FRCPC, Abstract Co-Author: Nothing to Disclose

Traumatic diaphragmatic rupture (DR) is an uncommon injury that can be lethal if not detected and treated in a timely manner. The purpose of our study was to evaluate the diagnostic accuracy of 64MDCT for the detection of DR in patients at our level 1 trauma centre.

We used our hospital's trauma registry to identify patients with a diagnosis of DR from January 1, 2008 to December 31, 2012. Only patients who had a 64MDCT scan at presentation and subsequently underwent laparotomy/laparoscopy were included in the study cohort. Using the surgical findings as the gold standard, the accuracy of prospective radiology reports was analyzed.

Of the 3225 trauma patients presented to our institution, 38(1.2%) had a DR. Fourteen of the 38 were excluded as they did not have MDCT pre-surgery. The cohort consisted of 20 males and 4 females with a median age of 34.5 years and a median Injury Severity Score of 26. Fifteen had a blunt trauma while 9 had a penetrating injury (PI). The overall sensitivity of the radiology reports was 66.7% (95% CI: 44.7- 84.3%), specificity was 100% (95% CI: 94-100%), PPV was 100% (95% CI: 79.2-100%) and NPV was 88.4 (95% CI: 78.4-94.8%) . The accuracy was 91%. However, only 3/9 with PI (33%) had a correct preoperative diagnosis. Most of the missed cases (4/6) had only indirect signs of injury.

The detection of DR in trauma patients on 64MDCT can be improved, especially in patients presenting with PI. Most missed cases occurred because the possibility of DR was not raised despite the presence of indirect evidence.  

The prospective diagnosis of DR remains challenging despite advances in CT technology and widespread use of 64MDCT.

Leung, V, Reid, S, Coates, A, Patlas, M, Are We Missing Traumatic Diaphragmatic Rupture?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000128.html