Diaphragm rupture

Case contributed by Stefan Tigges
Diagnosis certain

Presentation

Motor vehicle collision.

Patient Data

Age: 35 years
Gender: Female
x-ray
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Multiple loops of bowel in the left chest with rightward displacement of the mediastinum suspicious for left diaphragm rupture.

ct
This study is a stack
Axial lung
window
This study is a stack
Axial C+
arterial phase
This study is a stack
Coronal C+
arterial phase
This study is a stack
Sagittal C+
arterial phase
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Acute displaced fractures of the right anterolateral third through eighth ribs. Large defect in the left hemidiaphragm with herniation of the stomach, pancreatic tail, splenic flexure of the colon and multiple small bowel loops into the left hemithorax.

Case Discussion

The left hemidiaphragm is more commonly injured than the right. Displacement of bowel into the chest seen on a plain radiograph is highly suspicious for diaphragmatic rupture: the diagnosis is best confirmed on CT reformats in the coronal/sagittal planes.

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