Presentation
This 70 year old male was involved in a high speed motor vehicle accident. A CT trauma series was performed.
Patient Data
Unusual thickened appearance of the anterior part of the right hemidiaphragm suggest either hematoma or partial avulsion of fibers from the adjacent costal cartilage.
Case Discussion
Diaphragmatic avulsion is a rare clinical entity in adults. It occurs when the diaphragmatic fibers 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 fibers.
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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