Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 10, 2026:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 3.00
Procedures: 3.00
Neck and Chest: 1.50
Abdomen and Pelvis: 1.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

Radiography: 1.50
Procedures: 1.50
Thorax and Abdomen Procedures: 1.50

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Abdominal Section: 1.50
Thoracic Section: 1.50

Outline

1. Introduction
2. Embryology and Anatomy
3. Nontraumatic Abnormalities
   1. Overview
   2. Congenital Diaphragmatic Hernia
   3. Spontaneous Rupture
   4. Endometriosis-Related Diaphragmatic Disease
      1. Diaphragmatic Endometriosis
      2. Catamenial Pneumothorax
   5. Eventration and Paralysis
   6. Infection
   7. Thoracoabdominal Fistulas
      1. Hepatothoracic Fistula
      2. Pancreaticothoracic Fistula
      3. Gastrothoracic Fistula
      4. Colothoracic Fistula
4. Traumatic Abnormalities
   1. Overview
   2. Blunt Diaphragmatic Injury
      1. Definition and Epidemiology
      2. Mechanism of Action
   3. Radiographic Findings
   4. CT Findings
      1. Direct Signs of BDI
      2. Indirect Signs of BDI
      3. Indeterminate Signs of BDI
   5. Penetrating Diaphragmatic Injury
      1. Definition and Epidemiology
      2. Mechanism of Action
      3. Location
      4. Radiographic Features
      5. CT Features
   6. Importance of Early Recognition
   7. Management
5. Conclusion

Objectives

Upon completion of this course, students will:

1. identify nontraumatic diaphragmatic abnormalities
2. identify the imaging modality that is considered superior for traumatic diaphragmatic injuries
3. understand the possible outcomes related to acute diaphragmatic abnormalities
4. be familiar with the thickness of the fully formed diaphragm
5. know which condition can mimic discontinuity of the diaphragm’s edge
6. recognize the key aspect regarding the management of nontraumatic diaphragmatic abnormalities
7. be familiar with the location of Morgagni hernias
8. be familiar with the sign of herniation visible in radiographs
9. identify which imaging modality allowing better characterization of hernia sac contents, pulmonary volume, and associate malformations in fetal cases
10. know the causes for spontaneous diaphragmatic ruptures
11. be familiar with modalities use to confirm spontaneous diaphragmatic ruptures
12. be familiar with the symptoms of diaphragmatic endometriosis
13. understand how the definitive diagnosis for diaphragmatic endometriosis is confirmed
14. be familiar with the characteristics of catamenial pneumothorax
15. recognize the parts of the diaphragm primarily affected by diaphragmatic eventration
16. be familiar with the diseases that can cause diaphragmatic dysfunction
17. be familiar with the anatomy associated with diaphragmatic weakness or paralysis
18. understand the ultrasound findings in patients with diaphragmatic dysfunction
19. identify the key features of diaphragmatic abscesses on CT imaging
20. be familiar with the causes of an acquired thoracoabdominal fistula
21. understand the use of contrast-enhanced MRI cholangiography for confirmation of a thoracoabdominal fistula
22. be familiar with serious risks associate with pancreaticothoracic fistulas and the pericardium
23. understand the findings on chest radiography seen in gastrothoracic fistulas
24. identify the differing types of colothoracic fistulas
25. be familiar with the advantages of using CT with MPR for diagnosing diaphragmatic injury
26. know the typical size range for diaphragmatic injuries
27. be familiar with the “collar sign” in radiography
28. understand how the sensitivity of herniation through a diaphragmatic defect is an indicator of diaphragmatic injury
29. be familiar with the causes of hypoattenuation seen in the band sign
30. know which factors make dependent viscera less reliable for diagnosing diaphragmatic injury
31. be familiar with the potential mimics for the sign of elevated intra-abdominal organs
32. know the most common cause of penetrating diaphragmatic injuries
33. be familiar with the use of CT scan for suspected diaphragmatic injury
34. know how the specificity of the discontinuous diaphragm sign relates to penetrating trauma
35. understand the management of transdiaphragmatic intercostal hernias
36. understand the management of traumatic diaphragmatic injuries
37. understand the course of action for patients with various diaphragmatic defects