Thoraco-abdominal multitrauma with diaphragmatic rupture
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Dayu Gai had no recorded disclosures.View Dayu Gai's current disclosures
The patient was involved in a high speed motor vehicle accident. A CT trauma series was performed.
Loading Stack -
0 images remaining
- Small right and moderate left hemopneumothoraces
- Bilateral multilevel rib fractures
- T8 and T10, L1 and L4 single column vertebral fractures
- Right adrenal hemorrhage
- Left anterolateral diaphragmatic rupture
2 case questions available
Adrenal injury is uncommon due to the retroperitoneal location of the adrenal gland 2. It has been noted to occur in 2-3% of blunt abdominal injury 3, with motor vehicle accident being the most common cause. It is worth noting that right sided adrenal trauma is much more common than the left, with a ratio of 3-4:1 being quoted 1,2. This has been suggested to be caused by the short right adrenal vein which directly connects to the inferior vena cava. In blunt trauma, rapid increases in IVC pressure are likely associated with right adrenal trauma.
Complications of adrenal injury include uncontrolled hemorrhage and adrenal insufficiency.
This complex multitrauma case highlights a case of right adrenal hemorrhage. Adrenal hemorrhage is the most common type of adrenal trauma.
Diaphragmatic rupture is another traumatic finding, commonly found in blunt trauma (motor vehicle accidents and falls from height). The left sided diaphragm is usually involved. This has been speculated because of an intrinsically weaker left sided diaphragm, or because the liver on the right side provides protection 4. Diaphragmatic rupture is clinically relevant because it may result in herniation and strangulation of intra-abdominal viscera into the thoracic cavity 5. While the gold standard of diagnosis and treatment has been laparotomy, minimally invasive methods including video-assisted thorascopic surgery are gaining favor 6.
Case contributed by A/Prof. Pramit Phal.
- 1. Radiopaedia - Adrenal Gland trauma; http://radiopaedia.org/articles/adrenal-gland-trauma
- 2. Lee YS, Jeong JJ, Nam KH et-al. Adrenal injury following blunt abdominal trauma. World J Surg. 2010;34 (8): 1971-4. doi:10.1007/s00268-010-0537-x - Pubmed citation
- 3. Sinelnikov AO, Abujudeh HH, Chan D et-al. CT manifestations of adrenal trauma: experience with 73 cases. Emerg Radiol. 2007;13 (6): 313-8. doi:10.1007/s10140-006-0563-z - Pubmed citation
- 4. E-Medicine: Diaphragmatic Injuries; http://emedicine.medscape.com/article/822999-overview
- 5. Dwivedi S, Banode P, Gharde P et-al. Treating traumatic injuries of the diaphragm. J Emerg Trauma Shock. 2010;3 (2): 173-6. doi:10.4103/0974-2700.62122 - Free text at pubmed - Pubmed citation
- 6. Leppaniemi AK. Thoracoscopy in chest trauma: an update. Trauma. 2001;3:111–7
1 article features images from this case
16 public playlists include this case
- 2021 전문의 2차 : chest by JIEUN SHIN
- Imanabdo (part 3) by Iman Fani
- Patología del diafragma by Antonio Jesús
- Abdo by Chris Sia
- thoracic by Ahmed Mohamed Eid Mahgoub
- Trauma by Ahmed Mohamed Amin
- Abdomen by Ahmed Mohamed Amin
- Abdomen by Laura
- 3. Chest by Kim Dohyung
- 5th october by Aditya Sharma
- 00000000001 by Susheel K
- GI quiz visto by Antonio Jesús
- For Yo by Ahmed Mohamed Amin
- Abdo - My EDIC Practice by Lorinc
- Primer - Gastrointestinal - Peritoneum and Abdominal Wall by Aman
- ss195 by Susheel K