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The "Dependent Viscera" Sign in CT Diagnosis of Blunt Traumatic Diaphragmatic Rupture

Diane Bergin1, Rachel Ennis, Ciaran Keogh, Helen M. Fenlon and John G. Murray

1 All authors: Department of Radiology, Mater Misercordiae Hospital, Eccles St., Dublin 7, Ireland.



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  		Fig. 1. —32-year-old man with left-sided diaphragmatic rupture. Axial CT scan shows discontinuity of left hemidiaphragm (arrows indicate extent of diaphragmatic tear) with gastric and left renal herniation. Stomach lies dependent on left posterior ribs, which is positive "dependent viscera" sign.

 


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  		Fig. 2. —32-year-old woman with ruptured right hemidiaphragm. Axial CT scan shows right lobe of liver dependent on right posterior ribs (black arrows), which is "dependent viscera" sign. Partial waistlike constriction (white arrow)—collar sign—is visible along anterior surface of right lobe of liver and is attributable to partial hepatic intrathoracic herniation.

 


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  		Fig. 3. —40-year-old man with ruptured right hemidiaphragm. Axial CT scan shows mediastinal shift to left. Right lobe of liver is dependent against right posterior ribs (arrow), a positive "dependent viscera" sign.

 


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  		Fig. 4. —58-year-old woman with ruptured right hemidiaphragm. Axial CT scan shows herniation of small-bowel loops, which are dependent against right posterior ribs, a positive "dependent viscera" sign.

 


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  		Fig. 5. —17-year-old boy with surgically confirmed ruptured left hemidiaphragm. Axial CT scan shows stomach dependent against posterior left ribs (arrow), a positive "dependent viscera" sign.

 


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  		Fig. 6. —28-year-old man after blunt abdominal trauma. Axial CT scan shows hemoperitoneum (arrow) but normally positioned liver and spleen held in anterior suspension by intact hemidiaphragm. Intact diaphragm was confirmed at surgery.

 

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