Which hemidiaphragm is more likely to be injured?
Left sided diaphragmatic injuries are three times more common that right sided injury. This is thought to be due to an area of congenital weakness in the posterolateral diaphragm on the left as well as a protective effect from the liver on the right. Bilateral and central injuries are uncommon.
- Moderate left haemopneumothorax.
- Left lung contusions.
- Traumatic left hemidiaphragm rupture with herniation of mesenteric fat and large and small bowel into the left hemithorax.
- Non-displaced fracture of the manubrium, extending more to the left, with associated anterior mediastinal haematoma.
- There is a small gas locule in the right side of the posterior mediastinum and a small locule of left-sided retrocrural gas. No definite oesophageal injury identified.
- Soft tissue stranding in the lateral aspect of the right breast is likely due to haematoma/contusion.
- Multiple right-sided anterolateral rib fractures: 2-7th ribs.
- Multiple left-sided rib fractures: 1st rib posteriorly, 2nd and 3rd ribs anteriorly and 6th-10th ribs laterally. There is marked displacement of the inferior rib fractures with herniation of small and large bowel into the left lateral thoracic and abdominal wall.
- Large volume of free intraperitoneal gas.
- Splenic flexure perforation.
- Defect in the left lateral abdominal wall with herniation small and large bowel into the left lateral thoracic and abdominal wall.
- Small splenic laceration (AAST Grade I).
- Very small volume of free intraperitoneal fluid.
- Left lower anterior abdominal wall contusion (seat-belt sign) with contrast blush and left rectus haematoma with foci of active bleeding. Right linear semilunaris blush.
- Collapsed IVC consistent with hypovolaemia.
- Non-displaced avulsion fracture of the left transverse process of T12.
- Compression fracture of the superior endplate of L3 associated with 40% loss of vertebral body height.
- Compression fracture of the superior endplate of L4 with minimal displacement or loss of height.
- Left L1 and L2 transverse process fractures.
- Grade 1 (4 mm) anterolisthesis of L4 on L5.
- Incompletely imaged 15 mm right lobe of thyroid nodule.