Collar sign of diaphragmatic rupture

Case contributed by Harish Narayanan
Diagnosis certain


Incidental finding on routine preoperative chest radiograph, further imaged with CT.

Patient Data

Age: 17 years
Gender: Male

Coronal and sagittal CT images show herniation of a part of the liver through a chronic right diaphragmatic rupture. Indentation of the liver by the diaphragm at the margins of the defect results in a characteristic waist like constriction, referred to as collar sign. 

Case Discussion

The collar sign sign, also called hourglass sign or cottage loaf sign, refers to a waist like constriction involving the contour of the herniated viscera including liver, bowel etc at the margins of the defect in diaphragmatic rupture. It is helpful in differentiating diaphragmatic rupture from other conditions such as chronic eventration and paralysis.

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