Angiographic findings in diaphragmatic rupture.

The incidence of traumatic rupture of the diaphragm has increased during the past decade, a reflection of the increased number of high speed automobile accidents. The left hemidiaphragm is more commonly ruptured by blunt abdominal trauma.' Occasionally, however, a right hemidiaphragmatic rupture may allow the liver to herniate into the chest. Rupture of the left hemidiaphragm is generally diagnosed in the emergency room from the initial clinical examination supplemented by chest and zbdominal radiographs.,' If stomach or bowel have herniated, the radiographs usually have a characteristic appearance. However, herniation of the spleen is more difficult to establish. Accompanying splenic, hepatic, mesenteric or renal rupture is frequent, and hemothorax is not unusual." Diagnosis of a ruptured right hemidiaphragm may be difficult and the condition may not be suspected until the patient is recovering from other injuries. The usual roentgenographic findings are pleural effusion, basal atelectasis and an apparent elevation of the right hemidiaphragm. Since herniation of the colon and small bowel is uncommon on the right, barium studies are generally inconclusive. A pneumoperitoneum may establish the diagnosis, but occlusion of the diaphragmatic tear by the herniated structures can prevent free passage of air from the peritoneal to the pleural space.'." Since the diagnosis of diaphragmatic rupture is occasionally difficult, angiography may be useful. In addition, unsuspected ruptures may be present in patients who are being evaluated for other types of visceral trauma. We are therefore presenting the angiographic abnormalities observed in four patients with diaphragmatic rupture.