Presentation
Motor vehicle collision.
Patient Data
Endotracheal and nasogastric tubes appropriately positioned. Gaseous distension of the stomach. Consoludation right lung, likely pulmonary contusion. Subcutaneous emphysema right chest wall. Rounded soft tissue opacity just above right diaphram.
Bilateral lung contusions, multiple right rib fractures, small pleural effusions, small/moderate right pneumothorax. Right diaphragm defect containing liver and peritoneal fat herniating into the right chest.
Two right chest tubes: the proximal side port of the lateral chest tube is outside the right hemithorax, the medial chest tube is appropriately positioned. Endotracheal and nasogastric tubes are appropriately positioned. Right lung contusion. Subcutaneous emphysema right chest wall, but no pneumothorax. Normal contour right hemidiaphragm.
Case Discussion
Most diaphragm injuries involve the left and not the right diaphragm. Although the diagnosis was suspected on the initial radiograph which showed abnormal soft tissue above the right diaphragm, the diagnosis is easily made on CT, especially in the sagittal plane.
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