- TDIs most commonly occur after penetrating trauma
- Left diaphragm is more commonly ruptured than the right
- About 50% of TDI are diagnosed acutely
- The most commonly herniated organ is spleen
- 'Dependent viscera sign' is a very sensitive CT sign in the diagnosis of TDI
Notes: TDIs commonly occur after blunt trauma as in RTA or fall. Because of the liver, the right hemidiaphragm is ruptured less common than the left. Only about 10% of TDIs are diagnosed in acute setting. Stomach is most commonly herniated organ (32%), followed by colon (27%). CT is investigation of choice even in the acute setting. 'Dependent viscera sign' on CT is very sensitive in the diagnosis of TDI. The bowel or abdominal viscera usually do not contact the ribs due to seperation by diaphragm; contact indicates diaphragmatic injury and is known as 'dependent viscera sign'. Sagittal reconstruction is most sensitive and specific in the diagnosis of TDI.
Reference:
