CTICasesDelayed Presentation of Traumatic Diaphragmatic Hernia (Dependent Viscera Sign)
Imaging findings
In a 38-year-old woman with acute-onset chest pain following a recent respiratory illness, coronal and sagittal chest imaging shows a peaked, discontinuous left hemidiaphragm with intact muscle anteriorly and laterally but abrupt loss of the diaphragmatic contour more posteriorly, where stomach and spleen are seen abutting the chest wall directly -- the dependent viscera sign.
Key takeaways
A focal diaphragmatic discontinuity with a preserved, robust crus and dependent abdominal viscera abutting the chest wall, in a patient with a remote unevaluated motor vehicle collision roughly a decade earlier, suggests a chronic partial-thickness diaphragmatic tear that progressed to full-thickness rupture with an acute precipitant (here, a recent respiratory illness with forceful coughing); a healthy-appearing crus argues against a congenital or chronically paralyzed diaphragm as the explanation.
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