Case Of the Week (COW) 05 June 2016
TRAUMATIC DIAPHRAGMATIC RUPTURE WITH HERNIATION OF LIVER
Findings
SCANOGRAM
Well defined radioopacity noted in the lower zone of right hemithorax ,partly seen through the diaphragm adjacent to the cardiac shadow . Superior border is well defined . Opacity not silhouetting right heart border or right hemidiaphragm.
CT
Mediastinal window Axial sections show Well defined spherical soft tissue density with well defined borders noted in the basal segments of right lower lobe which does not show contrast enhacement. On sagittal images the ‘lesion’ appears to be arising from the liver segment VII ,showing same density as the liver parenchyma.
Discussion
Cottage loaf sign occurs as a result of right sided diaphragmatic rupture with partial herniation of liver through the diaphragmatic defect. The herniated component is separated by a waist at the diaphragm from the larger intraabdominal component. The shape looks like a cottage loaf , a particular shape of bread in which larger and smaller roughly spherical balls are squashed together forming a cottage shape.
Reference: 1. Roche CJ, O'Keeffe DP, Lee WK et-al. Selections from the buffet of food signs in radiology. Radiographics. 2002;22 (6): 1369-84. Radiographics (full text) - doi:10.1148/rg.226025521 - Pubmed citation 2. Hussain M, Al Damegh S. Food signs in radiology. Int J Health Sci (Qassim). 2011;1 (1): 143-54. Free text at pubmed - Pubmed citation
TRAUMATIC DIAPHRAGMATIC RUPTURE WITH HERNIATION OF LIVER
Findings
SCANOGRAM
Well defined radioopacity noted in the lower zone of right hemithorax ,partly seen through the diaphragm adjacent to the cardiac shadow . Superior border is well defined . Opacity not silhouetting right heart border or right hemidiaphragm.
CT
Mediastinal window Axial sections show Well defined spherical soft tissue density with well defined borders noted in the basal segments of right lower lobe which does not show contrast enhacement. On sagittal images the ‘lesion’ appears to be arising from the liver segment VII ,showing same density as the liver parenchyma.
Discussion
Cottage loaf sign occurs as a result of right sided diaphragmatic rupture with partial herniation of liver through the diaphragmatic defect. The herniated component is separated by a waist at the diaphragm from the larger intraabdominal component. The shape looks like a cottage loaf , a particular shape of bread in which larger and smaller roughly spherical balls are squashed together forming a cottage shape.
Reference: 1. Roche CJ, O'Keeffe DP, Lee WK et-al. Selections from the buffet of food signs in radiology. Radiographics. 2002;22 (6): 1369-84. Radiographics (full text) - doi:10.1148/rg.226025521 - Pubmed citation 2. Hussain M, Al Damegh S. Food signs in radiology. Int J Health Sci (Qassim). 2011;1 (1): 143-54. Free text at pubmed - Pubmed citation