Iatrogenic diaphragm rupture
Shortness of breath and reduced saturation after left nephrectomy.
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There is diagnostic contrast opacification of the pulmonary arteries. There is no pulmonary embolus.
Left posterior diaphragmatic rupture with fat tissue and small bubbles from the retropneumoperitoneum protruding into the left thorax. There is a large left pleural effusion associated with partial collapse of the left lower lung.
Small pleural effusion on the right associated with mild adjacent atelectasis.
The lungs are otherwise clear. There is no lymph node enlargement or other mediastinal abnormality.
This patient came to the radiology department to investigate possible pulmonary embolism in the setting of left nephrectomy performed one day ago. CTPA study showed no evidence of PE and identified an iatrogenic rupture of the posterior aspect of the diaphragm on the left associated with large pleural effusion.