Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT

John G. Murray, Elaine Caoili, James F. Gruden, Scott J J Evans, Robert A. Halvorsen, Robert C. Mackersie

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS. Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently reviewed by three observers who were unaware of surgical findings. Retrospective note was made of diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waistlike constriction of bowel ('collar sign'), and associated findings. Right and left hemidiaphragms were graded as intact or ruptured, and these findings were correlated with surgical findings. Individual and average observer sensitivity and specificity in detecting acute diaphragmatic rupture were calculated. RESULTS. Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the 'collar sign' was seen in four cases. Hemoperitoneum or hemothorax completely obscured visualization of the ruptured diaphragm in three cases. Individual diagnostic sensitivity for detecting diaphragmatic rupture was 54-73%, and specificity was 86-99%. Average sensitivity for the three observers was 61% (95% confidence interval, 41-81%), and average specificity was 87% (95% confidence interval, 76-99%). CONCLUSION. CT is highly specific in diagnosing acute diaphragmatic rupture and detects approximately two thirds of acute diaphragmatic ruptures after blunt trauma.

Original languageEnglish (US)
Pages (from-to)1035-1039
Number of pages5
JournalAmerican Journal of Roentgenology
Volume166
Issue number5
StatePublished - May 1996

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Diaphragm
Rupture
Sensitivity and Specificity
Wounds and Injuries
Confidence Intervals
Hemoperitoneum
Hemothorax
Patient Rights
Constriction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Murray, J. G., Caoili, E., Gruden, J. F., Evans, S. J. J., Halvorsen, R. A., & Mackersie, R. C. (1996). Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT. American Journal of Roentgenology, 166(5), 1035-1039.

Acute rupture of the diaphragm due to blunt trauma : Diagnostic sensitivity and specificity of CT. / Murray, John G.; Caoili, Elaine; Gruden, James F.; Evans, Scott J J; Halvorsen, Robert A.; Mackersie, Robert C.

In: American Journal of Roentgenology, Vol. 166, No. 5, 05.1996, p. 1035-1039.

Research output: Contribution to journalArticle

Murray, JG, Caoili, E, Gruden, JF, Evans, SJJ, Halvorsen, RA & Mackersie, RC 1996, 'Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT', American Journal of Roentgenology, vol. 166, no. 5, pp. 1035-1039.
Murray JG, Caoili E, Gruden JF, Evans SJJ, Halvorsen RA, Mackersie RC. Acute rupture of the diaphragm due to blunt trauma: Diagnostic sensitivity and specificity of CT. American Journal of Roentgenology. 1996 May;166(5):1035-1039.
Murray, John G. ; Caoili, Elaine ; Gruden, James F. ; Evans, Scott J J ; Halvorsen, Robert A. ; Mackersie, Robert C. / Acute rupture of the diaphragm due to blunt trauma : Diagnostic sensitivity and specificity of CT. In: American Journal of Roentgenology. 1996 ; Vol. 166, No. 5. pp. 1035-1039.
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abstract = "OBJECTIVE. The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS. Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently reviewed by three observers who were unaware of surgical findings. Retrospective note was made of diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waistlike constriction of bowel ('collar sign'), and associated findings. Right and left hemidiaphragms were graded as intact or ruptured, and these findings were correlated with surgical findings. Individual and average observer sensitivity and specificity in detecting acute diaphragmatic rupture were calculated. RESULTS. Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the 'collar sign' was seen in four cases. Hemoperitoneum or hemothorax completely obscured visualization of the ruptured diaphragm in three cases. Individual diagnostic sensitivity for detecting diaphragmatic rupture was 54-73{\%}, and specificity was 86-99{\%}. Average sensitivity for the three observers was 61{\%} (95{\%} confidence interval, 41-81{\%}), and average specificity was 87{\%} (95{\%} confidence interval, 76-99{\%}). CONCLUSION. CT is highly specific in diagnosing acute diaphragmatic rupture and detects approximately two thirds of acute diaphragmatic ruptures after blunt trauma.",
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N2 - OBJECTIVE. The purpose of this study was to determine the diagnostic sensitivity and specificity of CT in detecting acute rupture of the diaphragm after blunt trauma. MATERIALS AND METHODS. Abdominal CT scans taken before surgery of 11 patients with diaphragmatic rupture (eight left and three right) and 21 patients with intact diaphragms after major acute blunt abdominal trauma were independently reviewed by three observers who were unaware of surgical findings. Retrospective note was made of diaphragmatic discontinuity, intrathoracic herniation of abdominal contents, waistlike constriction of bowel ('collar sign'), and associated findings. Right and left hemidiaphragms were graded as intact or ruptured, and these findings were correlated with surgical findings. Individual and average observer sensitivity and specificity in detecting acute diaphragmatic rupture were calculated. RESULTS. Of the 11 cases of diaphragmatic rupture, diaphragmatic discontinuity was seen in eight, visceral herniation was seen in six, and the 'collar sign' was seen in four cases. Hemoperitoneum or hemothorax completely obscured visualization of the ruptured diaphragm in three cases. Individual diagnostic sensitivity for detecting diaphragmatic rupture was 54-73%, and specificity was 86-99%. Average sensitivity for the three observers was 61% (95% confidence interval, 41-81%), and average specificity was 87% (95% confidence interval, 76-99%). CONCLUSION. CT is highly specific in diagnosing acute diaphragmatic rupture and detects approximately two thirds of acute diaphragmatic ruptures after blunt trauma.

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