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Case 4 - Diaphragmatic slip pseudotumor

from Section 1 - Diaphragm and adjacent structures

Published online by Cambridge University Press:  05 November 2011

Fergus V. Coakley
Fergus V. Coakley
Affiliation:
University of California, San Francisco
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Summary

Imaging description

Prominent muscular slips of the diaphragm may be seen as soft-tissue nodules in contiguity with the diaphragm on CT or MRI (Figures 4.1 and 4.2) [1, 2].

Importance

Prominent diaphragmatic slips may mimic perihepatic metastatic implants, resulting in unnecessary follow-up investigations and patient anxiety.

Typical clinical scenario

Prominent diaphragmatic slips are described as being more frequent in deep inspiration [1]. Such diaphragmatic pseudotumors are also commoner in elderly or emphysematous patients [3].

Differential diagnosis

The distinction of prominent diaphragmatic slips from true peritoneal implants is based on their continuity peripherally with the diaphragm, curvilinear course when tracked over serial slices, and separation from adjacent viscera by subdiaphragmatic fat. Decubitus and expiratory CT sections are also said to help [1].

Teaching point

An apparent peritoneal implant abutting the diaphragm should be examined closely in order to make an accurate distinction from a prominent diaphragmatic slip.

Type
Chapter
Information
Pearls and Pitfalls in Abdominal Imaging
Pseudotumors, Variants and Other Difficult Diagnoses
 , pp. 10 - 11
Publisher: Cambridge University Press
Print publication year: 2010

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References

Rosen, A, Auh, YH, Rubenstein, WA, et al. CT appearance of diaphragmatic pseudotumors. J Comput Assist Tomogr 1983; 7: 995–999.CrossRefGoogle ScholarPubMed
Schwartz, EE, Wechsler, RJ.Diaphragmatic and paradiaphragmatic tumors and pseudotumors. J Thorac Imaging 1989; 4: 19–28.CrossRefGoogle ScholarPubMed
Caskey, CI, Zerhouni, EA, Fishman, EK, Rahmouni, AD.Aging of the diaphragm: a CT study. Radiology 1989; 171: 385–389.CrossRefGoogle ScholarPubMed

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