Under the dome {diaphragm}---what lies beneath…?

Congress:

ECR 2019

Poster Number:

C-3279

Type:

Educational Exhibit

Keywords:

Thorax, Anatomy, Conventional radiography, Digital radiography, Diagnostic procedure, Education, Normal variants, Acute, Infection

Authors:

N. Ramesh; Portlaoise/IE

DOI:

10.26044/ecr2019/C-3279

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-3279

Fig. 1: The domes of diaphragm

Fig. 2: Air filled stomach beneath the left dome

Fig. 3: Chilaiditi sign :Colonic interposition between liver and right dome

Fig. 4: Transverse colon beneath the domes

Learning objectives

The purpose of this educational poster is to review the normal appearances below the diaphragm, the normal variants and variety of pathological changes seen on Chest radiographs {CXR}

Background

The chest radiograph remains one of the most requested radiological examinations worldwide. Despite this a large number of lesions are missed by requesting physicians and reporting radiologists. There several reviews areas whilst reporting the Chest radiographs. Reviewing the regions below the domes of diaphragm is one of the important review areawhilst reporting chest radiograph.

Findings and procedure details

Gastric bubble under the left dome of diaphragm is one of the commonest appearances; occasionally a subtle tumour can be sometimes seen. Interposition of the hepatic flexure between the liver and the right dome diaphragm is a normal variant; below the left dome the gastric bubble and sometimes the splenic flexure are visible. Free air under the diaphragm {pneumoperitoneum] is probably the most important of pathology that should not be missed as this finding may be very subtle. Pathology of the liver, gall bladder, spleen,...

Conclusion

Whilst reporting Chest Radiographs, the reporting Radiologist should review the area below the diaphragm to avoid missing important findings for better patient diagnosis and management

Personal information

NAGABATHULA RAMESH RADIOLOGY DEPARTMENT MIDLAND REGIONAL HOSPITAL PORTLAOISE IRELAND

References

Interpretation of the chest radiograph: Puddy E et al: Continuing education in anaesthesia critical care & Pain; Vol 7, Issue 3, June 2007: p 71-75; https://doi.org/10.1093/bjaceaccp/mkm014 Imaging of the Diaphragm: Anatomy and Function: Nason LK et al: Radiographics, 2012 32:2, E51-E70; doi: 10.1148/rg.322115127 Fat under diaphragm simulating pneumoperitoneum: Luis O. MartinezandMichael M. Raskin: The British Journal of Radiology197447:558,308-30; https://doi.org/10.1259/0007-1285-47-558-308 Acute Abdominal Pain Secondary to Chilaiditi Syndrome, Kang D et al; Case Reports in Surgery, vol. 2013, Article ID 756590, 3 pages, 2013.https://doi.org/10.1155/2013/756590. The invisible gorilla...