| Summary: | Purpose: To investigate the diagnostic value of multi-slice computed tomography (MSCT) for combined
thoracoabdominal injury.
Methods: A retrospective study was conducted to analyze the clinical data and MSCT images of 68 patients
who sustained a combined thoracoabdominal injury associated with diaphragm rupture, and 18
patients without diaphragm rupture. All the patients were admitted and treated in the Chongqing
Emergency Medical Center (a level I trauma center) between July 2005 and February 2014. There were 71
males and 15 females with a mean age of 39.1 years (range 13e88 years). Among the 86 patients, 40
patients suffered a penetrating injury, 46 suffered a blunt injury as a result of road traffic accident in 21
cases, fall from a height in 16, and crushing injury in 9. The MSCT images were retrospectively reviewed
by two radiologists. The results of CT diagnosis were compared with surgical findings and/or follow-up
results.
Results: Among the 86 cases, diaphragm discontinuity was found in 29 cases, segmental nonrecognition
of the diaphragm in 14, diaphragmatic hernia in 21, collar sign in 14, dependent viscera sign in 18,
elevated abdominal organs in 21, bowel wall thickening and/or hematoma in 6, and pneumoperitoneum
in 8. CT diagnostic accuracy for diaphragm rupture was 88.4% in the right side and 90.7% in the left side.
CT diagnostic accuracy for hemopneumothorax, pulmonary contusion, mediastinal hemorrhage, kidney
and adrenal gland injuries was 100%, while for liver, spleen and pancreas injuries was 96.5%, 96.5%, 94.2%
respectively.
Conclusion: To reach an early diagnosis of combined thoracoabdominal injury, surgeons and radiologists
should be familiar with all kinds of images which might show signs of diaphragm rupture, such as diaphragm discontinuity, segmental nonrecognition of the diaphragm, dangling diaphragm sign, diaphragm
herniation, collar sign, dependent viscera sign, and elevated abdominal organs.
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