Traumatic diaphragmatic rupture

Case contributed by RMH Core Conditions

Presentation

10 days post MVA. Prior CT noted left four broken ribs and lung contusion. Increasing chest pain.

Patient Data

Age: 45
Gender: Male

Chest

Modality: X-ray

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. 

Chest

Modality: CT

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. 

Abdomen/Pelvis

Modality: CT

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 recognise on both radiographs and CT
  • complications from delayed recognition can be severe
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Case Information

rID: 27921
Case created: 27th Feb 2014
Last edited: 9th May 2016
System: Chest
Inclusion in quiz mode: Included

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