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Signs of diaphragmatic rupture on computed tomography.

The 'dependent viscera sign'

The dependent viscera sign is seen with diaphragmatic rupture when there is loss of the posterior support of the diaphragm, allowing the viscera to drop against the posterior ribs and obliterating the posterior costophrenic recess. The dependent viscera sign is said to be present on the right side if the upper one-third of the liver abuts the posterior ribs (Fig. 1) and on the left side if the stomach or bowel abuts the posterior ribs or lies posterior to the spleen. (1)

The 'collar sign' and the 'hump sign'

This is a waist-like constriction of the viscera (stomach, bowel) that can be seen in diaphragmatic ruptures when there is herniation of the viscera through the defect (Figs 2 and 3). It may be appreciated in all planes including axial computed tomography (CT). (2) The hump sign is a variant of the collar sign; it occurs as a result of a portion of liver herniating (Fig. 4) through the diaphragm, forming a hump-shaped mass.

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[FIGURE 2-3 OMITTED]

[FIGURE 4 OMITTED]

Aphrodite Gogakis, MB BCh

Amarit Kaur Bajwa,MB BS, FCRad (Diag) (SA)

Department of Diagnostic Radiology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg

(1.) Colin P, Cantwell MD. The dependent viscera sign. Radiology 2006; 238(2): 752-753.

(2.) Mirvis SE, Shanmuganagthan K. Imaging hemidiaphragmatic injury. Eur Radiol 2007; 17(6): 1411-1421.
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Title Annotation:TODAY'S TWO SIGNS
Author:Gogakis, Aphrodite; Bajwa, Amarit Kaur
Publication:South African Journal of Radiology
Article Type:Brief article
Geographic Code:6SOUT
Date:Apr 1, 2008
Words:230
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