Posterior Diaphragmatic Defect Detected on Chest CT: the Incidence according to Age and the Lateral Chest Radiographic Appearances

PURPOSE: We wanted to investigate the incidence of posterior diaphragmatic defect on chest CT in various age gropus and its lateral chest radiographic appearances. MATERIALS AND METHODS: The chest CT scans of 78 patients of various ages with posterior diaphragmatic defect were selected among 1,991 patients, and they were analyzed for the incidence of defect in various age groups, the defect location and the herniated contents. Their lateral chest radiographs were analyzed for the shape of the posterior diaphragm and the posterior costophrenic sulcus. RESULTS: The patients' ages ranged from 34 to 87 with the tendency of a higher incidence in the older patients. The defect most frequently involved the medial two thirds (n= 49, 50.4%) and middle one third (n=36, 37%) of the posterior diaphragm. The retroperitoneal fat was herniated into the thorax through the defect in all patients, and sometimes with the kidney (n=8). Lateral chest radiography showed a normal diaphragmatic contour (n=51, 49.5%), blunting of the posterior costophrenic sulcus (n=41, 39.8%), focal humping of the posterior diaphragm (n=7, 6.8%), or upward convexity (n=4, 3.9%) of the posterior costophrenic sulcus on the affected side. CONCLUSION: The posterior diaphragmatic defect discovered in asymptomatic patients who are without a history of peridiaphragmatic disease is most likely acquired, and this malady increases in incidence according to age. An abnormal contour of the posterior diaphragm or the costophrenic sulcus on a lateral chest radiograph may be a finding of posterior diaphragmatic defect.

Anterior Diaphragm Below the Xiphoid Process: CT Finding

PURPOSE: The aim of this study is to evaluate the normal anatomy of the anterior diaphragm below the level of the xiphoid process by analyzing CT scans. MATERIALS AND METHODS: CT scans of 100 patients with no peridiaphragmatic lesions were retrospectively analyzed. All CT scans were performed with coverage of the whole diaphragm in the inspiration state. We evaluated the type of the anterior diaphragm, according to Gale's classification, the discontinuity of the anterior diaphragm (defect), the presence of a focal protrusion of the diaphragm (beak), and the thin line continuous with the diaphragm (line), and the relationship between the internal thoracic artery and the anterior diaphragm. Ed. Note: confirm wording. RESULTS: The frequency of defect, beak, and line were 17%, 27%, and 9%, respectively. Beak mainly (18/27) arose from the fusion between the anterior diaphragm and the transversus abdominis. The internal thoracic artery seen on CT was always located in the anterior portion of the transversus abdominis or transversus thoracis. CONCLUSION: The discontinuity of the anterior diaphragm and the focal protrusion of the diaphragm that mimics a hernia are relatively common variations of the anterior diaphragm. The internal thoracic artery may not be the cause of Morgagni foramen.

Mesenteroaxial Volvulus in the Stomach Associated with Paraesophageal Hernia: Case Report

Gastric volvulus can either present as an acute or chronic symptoms according to the degree of gastric rotation and subsequent obstruction. The diagnosis of gastric volvulus is often difficult and is mainly based on imaging studies. We describe a case of mesenteroaxial gastric volvulus associated with paraesophageal hernia, well demonstrated on upper gastrointestinal (UGI) series and coronal reconstructed CT image.

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.