“A Stab in the Dark” Review of multidetector CT imaging findings in penetrating diaphragmatic injury and correlation with clinical outcome. A UK Level 1 Trauma Centre Perspective. S. Javed, M. Akhtar, S. West, T. Campion, S. Cross To understand the key role the Radiologist plays in diagnosing penetrating diaphragmatic injury. To illustrate the importance of multidetector CT in delineation of diaphragmatic rupture in Penetrating Trauma The CT signs in penetrating diaphragmatic injury can be subtle. We will demonstrate key findings along with potential pitfalls.

Introduction: •The Royal London Hospital is a Level 1 Trauma Centre in central London. •The number of stabbing related admissions to our Emergency Department has increased steadily year on year. •Penetrating trauma to the torso in the haemodynamically stable patient can cause damage that is clinically and radiologically subtle. •Left sided traumatic diaphragmatic injury is almost universally surgically repaired regardless of the mechanism. The CT imaging signs of penetrating diaphragmatic injury are not as well documented in the literature as those secondary to blunt trauma....

Methods: Level 1 UK Trauma centre Manual search through trauma database since April 2007 to Nov 2013 All CT’s were reported by a Senior Radiology registrar and approved by a Consultant. 66 patients admitted with penetrating abdominal injury and subsequently taken to theatre during this time Of the 65 patients, 20 patients did not have pre-operative CT, 4 died before they could have a CT, and 8 did not have surgery post injury (other form of treatment, conservative, endoscopy etc.), 33 patient had a pre-operative...

•Left sided penetrating diaphragmatic injury is a surgical emergency and requires prompt diagnosis.•With multidetector CT, the Radiologist plays a key role in diagnosing this, often subtle, injury.•By keeping diaphragmatic injury in mind particularly when reporting trauma involving penetrating injury – the radiologist is likely to improve their pick up of this difficult pathology.•Appropriate educations, investigations, and awareness will lead to more accurate diagnosis, and make reports more useful to the clinicians.•Being aware of the CT signs will aid in the diagnosis.

Additional Authors: Dr S. Javed - radiology registrar, Barts Health NHS Trust Dr M. Akhtar- radiology registrar, Barts Health NHS Trust

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