Right hemidiaphragmatic avulsion in trauma patient

Case contributed by Dr Dayu Gai

Presentation

This 70 year old male was involved in a high speed motor vehicle accident. A CT trauma series was performed.

Patient Data

Age: 70 years
Gender: Male

Unusual thickened appearance of the anterior part of the right hemidiaphragm suggest either haematoma or partial avulsion of fibres from the adjacent costal cartilage.

Case Discussion

Diaphragmatic avulsion is a rare clinical entity in adults. It occurs when the diaphragmatic fibres inserting onto the ribs are ruptured. It differs from diaphragmatic rupture, in that diaphragmatic rupture involves tearing of the diaphragmatic muscle body as opposed to the diaphratmatic insertion fibres.

In the literature, there has been only one case of delayed, isolated left-sided diaphragmatic avulsion occurring 5 years after severe multitrauma 1. In this case report, the initial blunt thoracic injury involved left scapula and humerus fractures, with the diaphragmatic injury initially being undetected. The patient presented five years after the precipitating incident with symptoms of bowel obstruction due to bowel loops herniating into the thoracic cavity.

In this patient, note the hypodense region located anterior and inferiorly relative to the right costal margin, suggesting a tearing of the right sided hemidiaphragm.

Case contributed by A/Prof. Pramit Phal.

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Case information

rID: 32001
Case created: 9th Nov 2014
Last edited: 16th Jul 2017
System: Chest
Inclusion in quiz mode: Included

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