Which single finding on the initial supine chest radiograph has the highest sensitivity for traumatic diaphragmatic rupture?
- A Nasogastric tube seen coiled within the left hemithorax ✓
- B Elevated hemidiaphragm
- C Mediastinal shift to the right
- D Left lower lobe atelectasis
Correct answer: A. Nasogastric tube seen coiled within the left hemithorax
Explanation
An NG tube coursing below the diaphragm then coiling back up into the thorax is pathognomonic for left-sided diaphragmatic rupture with gastric herniation. Elevated hemidiaphragm, mediastinal shift and basal atelectasis are nonspecific and occur with many conditions including simple pulmonary contusion. Plain films miss most diaphragmatic ruptures; MDCT with multiplanar reformats is the current standard when this sign is absent.
Reference: Grainger and Allison's Diagnostic Radiology, 7th ed.
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