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World J Radiol. Oct 28, 2016; 8(10): 819-828
Published online Oct 28, 2016. doi: 10.4329/wjr.v8.i10.819
Blunt diaphragmatic lesions: Imaging findings and pitfalls
Matteo Bonatti, Fabio Lombardo, Norberto Vezzali, Giulia A Zamboni, Giampietro Bonatti
Matteo Bonatti, Norberto Vezzali, Giampietro Bonatti, Department of Radiology, Bolzano Central Hospital, 39100 Bolzano, Italy
Fabio Lombardo, Giulia A Zamboni, Department of Radiology, University of Verona, 37100 Verona, Italy
Author contributions: Bonatti M and Lombardo F wrote the paper; all the authors collaborated in data collection and paper review.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Matteo Bonatti, MD, Department of Radiology, Bolzano Central Hospital, 5 Boehler St., 39100 Bolzano, Italy. matteobonatti@hotmail.com
Telephone: +39-0471-908494 Fax: +39-0471-908908
Received: March 30, 2016
Peer-review started: March 31, 2016
First decision: May 17, 2016
Revised: May 31, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: October 28, 2016
Abstract

Blunt diaphragmatic lesions (BDL) are uncommon in trauma patients, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. It is well known that BDL are often overlooked at initial imaging, mainly because of distracting injuries to other organs. Sonography may directly depict BDL only in a minor number of cases. Chest X-ray has low sensitivity in detecting BDL and lesions can be reliably suspected only in case of intra-thoracic herniation of abdominal viscera. Thanks to its wide availability, time-effectiveness and spatial resolution, multi-detector computed tomography (CT) is the imaging modality of choice for diagnosing BDL; several direct and indirect CT signs are associated with BDL. Given its high tissue contrast resolution, magnetic resonance imaging can accurately depict BDL, but its use in an emergency setting is limited because of longer acquisition times and need for patient’s collaboration.

Keywords: Diaphragm, Blunt injury, Trauma, Imaging, Computed tomography

Core tip: Blunt diaphragmatic lesions (BDL) are uncommon, but they should be promptly recognized as a delayed diagnosis increases morbidity and mortality. We herein discuss multi-modality imaging findings in BDL and possible pitfalls in order to help the radiologist in this sometimes-difficult diagnosis.