Radiology Resident Case of the Week
Etiology/Pathophysiology
Blunt abdominal trauma associated with rib fracture or ruptured spleen. 90% of cases initially missed.
Pathology:
90% on left. Stomach, kidney, spleen or bowel may be located above the diaphragm. 90% of strangulated diaphragmatic hernias are of traumatic origin.
Miscellaneous
Imaging
On plain film examination, pleural effusion, diaphragmatic irregularity, splenic or small bowel or gastric herniation may be seen. The abnormal location of a nasogastric tube may signal gastric herniation. Water-soluble contrast may be placed in peritoneal lavage tubing and its subsequent location examined, but the preferred method of visualizing contents above the diaphragm is now CT or MR.
DDX
Key references
Harris William H, Harris John, Novelline Robert A. The Radiology of Emergency Medicine. Baltimore: Williams and Wilkins, 1993. pp. 681-8.
Keats, Theodore E. Emergency Radiology. Chicago: Yearbook Medical Publishers, Inc., 1989. p. 184.
ACR Code
Keywords: