Crura Sign: Differentiation between Traumatic Rupture of the Diaphragm and Nontraumatic Elevation on CT

PURPOSE: To evalvate whether in patients with diffuse evaluation of a hemidiaphragm on chest radiographs, the apparence of the crura on CT might be helpful in differentiating between traumatic rupture of the diaphragm(TRD) and nontraumatic causes such as diaphragmatic palsy or diffuse diaphragmatic eventration. MATERIALS AND METHODS: Among patients with diffuse elevations of a hemidiaphragm on chest radiograph, 27 who had patients undergone CT scans were retrospectively reviewed. Twelve patients had surgically proven TRD, and 15 had nontraumatic elevation of a hemidiaphragm such as diaphragmatic palsy or diffuse diaphragmatic eventration. Under the hypothesis that the affected crus is markedly thinner than the normal side in nontraumatic elevation but is normal in TRD ("crura sign"), we optically assessed without measurement the thickness of both crura. RESULTS: In all patients with TRD, the thickness of the affected crus was similar to that of the contralateral side. In all patients with nontraumatic causes, however, the crus of the elevated hemidiaphragm was markedly thinner than of the normal side. CONCLUSION: The "crura sign" may be useful additional CT finding of traumatic rupture the diaphragm.

CT Anatomy of the Diaphragm: Changes in End Inspiration and End Expiration

PURPOSE: To assess the change in configuration of the diaphragm between scans obtained at end inspiration and end expiration. MATERIALS AND METHODS: Two series of CT scans at end inspiration and at end expiration were obtained in 37 patients. We evaluated the changes in the type of anterior diaphragm, pseudotumor, undulation ofthe diaphragm, and diaphragmatic defect during the respiratory phases. RESULTS: The configuration of the anterior portion of the diaphragm changed between end inspiratory and end expiratory CT scans in 25(67.6%) of 37 patients. Diaphragmatic defect, diaphragmatic pseudotumor, and undulation of the diaphragm were more frequent at end inspiration (13.5%, 18.9%, 37.8%, respectively) than at end expiration (0%, 5.4%, 10.8%, respectively). CONCLUSION: There is a change in the configuration of the anterior portion of the diaphragm and we also observed differences in the visualization of diaphragmatic defects, pseudotumor, and undulation between scans obtained at end inspiration and end expiration.

Angiographic Embokization in the Control of Bleeding Related to Gynecologic Malignancy / 대한부인종양콜포스코피학회잡지

The use of angiographic embolization gas been well described for the control of gynecologic bleeding. Recently, we have experienced the successful embolization in two case of serons bleeding related to giynecologic malignancy. Clinical evaluation revealed a gynecologic cancer with active bleeding. Becaause we judged that conservative management was unable to cuntrol the bleeding, we underwent an angiographic embolization. The result presented here indicates that angiographic embolization is a relatively safe, effective and rapid procedure that should be considered early in management of gynecohogic cancer bleeding that is unresponsive to conservative management.

Appearance of the Diaphragm: a CT Analysis

PURPOSE: We attempted to determine the frequency of the type of anterior diaphragm and diaphragmatic abnormalities, and to ascertain whether these two may be correlated with respiration and patient's age. MATERIALS AND METHODS: Two hundred abdominal CT scans that were obtained at end expiration and 150 chest CT scans that were obtained at end inspiration were retrospectively reviewed for the evaluation of anterior diaphragmatic appearance, diaphragmatic defect, pseudotumor, and undulation. We evaluated the frequency of these findings and the differences of diaphragmatic appearance between the group above 60 years and the group under 59 years. RESULTS: The most common type of anterior diaphragm was lower(50.0%) on chest CT scans and superior (32.5%) on abdominal CT scans;thus, a significant relationship with respiration was observed. Diaphragmatic defect, pseudotumor, and undulation were found in 15.1%, 16.0%, 22.6% of all 350 patients, respectively. Diaphragmatic defect did not change significantly with the respiration or the type of anterior diaphragm. Pseudotumor and undulation, which were more common on chest CT scans and the lower type of anterior diaphragm, demonstrated a trend to change with respiration. Diaphragmatic defect, pseudotumor, and undulation were more common in older age above 60 years(26.4%, 23.6%, 36.8%, respectively) than in under 59 years(7.3%, 10.7%, 12.6%, respectively). CONCLUSION: Anterior diaphragmatic appearances may not be constant but may change with respiration. Respiration and aging process may be the main causes of diaphragmatic abnormalities.