CTICasesTraumatic Right Hemidiaphragm Rupture
Imaging findings
Chest radiograph demonstrates low lung volumes but no definite pneumothorax. Chest CT reveals right-sided pleural air and free intra-abdominal air in the upper anterior abdomen, localized near the falciform ligament. Coronal and sagittal CT reformats demonstrate a direct communication between the right pleural space and the anterior abdominal cavity through a focal defect in the anterior right hemidiaphragm. Operative evaluation confirmed a 12-centimeter tear of the anterior right hemidiaphragm.
Key takeaways
Right-sided hemidiaphragmatic rupture is less common than left-sided injury due to the protective buffering of the liver, and typically results from severe blunt trauma or a sudden increase in intra-abdominal pressure. Coronal and sagittal CT reformats are highly valuable for identifying subtle communications and direct defects of the anterior diaphragm, which can be easily overlooked on axial views or initial radiographs.
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