CTICasesChronic Diaphragmatic Rupture
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Imaging findings
Chest CT demonstrates a defect in the left hemidiaphragm with herniation of intra-abdominal fat and colon into the left hemithorax. The "dependent viscera sign" is present, where herniated abdominal organs lie directly against the posterior ribs due to the loss of diaphragmatic support. Multiple healed left-sided rib fractures are also noted.
Key takeaways
Diaphragmatic rupture can occur after blunt trauma and may go undetected acutely, presenting years later as a chronic diaphragmatic hernia. Because of the negative intrathoracic pressure, abdominal contents can progressively herniate into the thorax over time, potentially causing respiratory distress or bowel obstruction, and necessitating surgical repair with mesh or primary closure.
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