Imaging description

A diaphragmatic slip is a muscular bundle or flap projecting from the inferior surface of the diaphragm (Figure 54.1A). They are most commonly seen incidentally on CT and are usually found in the superior right hepatic lobe [1]. On CT, diaphragmatic slips appear as wedge-shaped, round, or oval structures of muscle attenuation that range in size from 1 to 3.5 cm, and are surrounded by thin strips of fat attenuation (Figures 54.1B and 54.2). In many patients, multiple slips present at regular intervals on the liver surface of the right hepatic lobe. Occasionally, slips can course obliquely through the liver parenchyma, an appearance that can mimic a laceration (Figure 54.3). Sagittal and coronal reformations can better characterize their smooth course along the liver edge or within the liver parenchyma. Difficult cases may be resolved by following the slip along its long axis with ultrasound, decubitus CT, or CT in deep inspiration. The CT appearance of the slips corresponds well with their appearance on ultrasound where the slip appears as a highly echogenic structure indenting the liver edge [2].