Presentation
10 days post MVA. Prior CT noted left four broken ribs and lung contusion. Increasing chest pain.
Patient Data
A large gastric air-fluid level now projects in the lower half of the left hemithorax, mildly displacing the heart to the right. Left lower zone atelectasis and basal pleural effusion.
Left diaphragmatic rupture with herniation of the stomach into the left thoracic cavity, passive atelectasis of the left lower lobe and small pleural fluid collection.. Mediastinal structures are displaced to the right. Left sided rib fractures.
Left inguinal hernia containing loops of sigmoid colon as described previously.
CT from 10 days prior was available for review.
On retrospective review this injury (left diaphragmatic hernia) appears on the previous trauma CT (this one).
Case Discussion
The patient went to have a successful diaphragmatic repair.
Key learning points:
- an often missed injury (7-67% of the time) at time of injury
- most commonly occur in motor vehicle collisions (90% cases)
- can be difficult to recognize on both radiographs and CT
- complications from delayed recognition can be severe
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