Continuous diaphragm sign

Last revised by Mostafa Elfeky on 30 Jul 2020

The continuous diaphragm sign is a chest radiograph sign of pneumomediastinum or pneumopericardium if lucency is above the diaphragm, or of pneumoperitoneum if lucency is below the diaphragm. 

Normally the central portion of the diaphragm is not discretely visualized on chest radiographs as it merges with the cardiac silhouette. If the diaphragm can be seen continuously across the midline then this is highly suggestive of free gas within the mediastinum, pericardium or peritoneal cavity 1,3

It should not be confused with the double diaphragm sign in pneumothorax.

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