Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre Vincent A. Leung, MD, Michael N. Patlas, MD,

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Imaging of Traumatic Diaphragmatic Rupture: Evaluation of Diagnostic Accuracy at a Level 1 Trauma Centre Vincent A. Leung, MD, Michael N. Patlas, MD, FRCPC, Susan Reid, MD, FRCSC, Angela Coates, MEd, Savvas Nicolaou, MD, FRCPC Canadian Association of Radiologists Journal Volume 66, Issue 4, Pages 310-317 (November 2015) DOI: 10.1016/j.carj.2015.02.001 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 “Collar” sign. Coronal contrast-enhanced computed tomography image in a 37-year-old male post motor vehicle collision demonstrates constriction of the herniated stomach (S) as it passes through a left hemidiaphragmatic defect (arrows). Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 “Dependent viscera” sign. Axial (A) and sagittal (B) contrast-enhanced computed tomography images in a 95-year-old male with left traumatic diaphragmatic rupture post-MVC demonstrates loss of the expected interposed lung between the stomach (S) and the posterior chest wall (arrows). Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 3 “Hump and band” sign. Coronal contrast-enhanced computed tomography image in a 22-year-old male post-MVC with right traumatic diaphragmatic rupture demonstrates liver (L) herniating through a diaphragmatic defect (arrows) with a slight band of hypoattenuation at the constriction site that may be secondary to compression. Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 4 Missed focal diaphragmatic defects. Coronal contrast-enhanced computed tomography images (A and B) in a 25-year-old male who had been stabbed multiple times in the left chest demonstrate 2 tiny focal diaphragmatic defects (arrows) which were not detected prospectively. Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 5 Missed focal diaphragmatic defect. Axial contrast-enhanced computed tomography image in a 22-year-old male who had been stabbed in the left chest demonstrates a small focal diaphragmatic defect which was not detected prospectively (arrow). Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 6 Herniation of the liver (L) through a presumed defect of the right hemidiaphragm (arrows) is subtle in the coronal plane (A) but more conspicuous in the sagittal plane (B) in a 46-year-old female after an MVC. The diagnosis of TDR was made prospectively. Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 7 Coronal contrast-enhanced computed tomography image (A) in a 34-year-old male post-MVC demonstrates a left diaphragmatic defect (arrows) with herniation of fat which was not detected prospectively. The patient was reimaged 10 days later due to respiratory distress. A coronal image from a repeat contrast-enhanced computed tomography (B) demonstrates a larger diaphragmatic defect (arrows) with herniation of stomach (S) and colon (C) into the chest. Canadian Association of Radiologists Journal 2015 66, 310-317DOI: (10.1016/j.carj.2015.02.001) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions