A 40-year-old woman sustained blunt thoracoabdominal trauma in a fall. On CT, the stomach and spleen lie in direct contact with the posterior chest wall at the same level as the adjacent kidney, and there is a waist-like constriction of the herniated stomach at the diaphragmatic defect. Which combination of signs is being described?
- A Continuous diaphragm sign and NG tube sign of oesophageal rupture
- B Fallen lung sign and deep sulcus sign of bronchial transection
- C Collar sign and dependent viscera sign of left diaphragmatic rupture ✓
- D Halo sign and ring sign of hepatic avulsion
Explanation
On the supine CT, herniated abdominal viscera falling dependently against the posterior ribs constitutes the dependent viscera sign, highly specific for diaphragmatic rupture. C waist-like narrowing of the stomach or bowel where it traverses the tear is the collar sign. Both signs favour left-sided rupture because the left hemidiaphragm lacks the bare-area anchorage that protects the right side. The fallen lung sign indicates main bronchial transection, and the continuous diaphragm sign relates to pneumomediastinum, so those options describe unrelated entities.
Reference: Brant and Helms' Fundamentals of Diagnostic Radiology, 5th ed.
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Written and medically reviewed by the StethoPrep medical team.