Right-sided Diaphragm Rupture Incidentally Diagnosed by Coronal Views on Chest and Abdominal Computed Tomography

Abstract

A 57-year-old man was directly transported to our emergency department via the emergency medical service. The patient was found lying on the floor after a trauma. The initial chest computed tomography (CT) scan showed a suspicious diaphragm injury ( Fig. 1.) with thoracic aortic injury. The trauma team called an intervention radiologist who performed emergency thoracic endovascular aortic repair for aortic rupture. A follow-up abdominal CT scan for liver injury was performed to obtain more detailed information regarding a suspicious diaphragm injury. The herniated liver dome was more prominent (Fig. 2.), and we decided on surgical repair of the injured diaphragm. The patient was sent to the operating room and underwent thoracoscopic examination under double-lumen general endotracheal anesthesia.We found traumatic diaphragm injury and herniation of the liver dome (Fig. 3.). The herniated liver dome was strangulated and had superficial laceration on the surface without active bleeding. We performed a lateral thoracotomy and repaired the injured diaphragm with nonabsorbable sutures in an airtight manner (Fig. 4.). The right- A 57-year-old man was transferred to the emergency department of our trauma center because of decreased mentality. Chest computed tomography (CT) showed multiple rib fractures, aortic arch rupture, and suspicious diaphragm rupture. An intervention radiologist performed emergency thoracic endovascular aortic repair for traumatic aortic rupture. The coronal view of a follow-up abdominal CT scan revealed advanced herniation of the liver dome. The patient underwent a thoracoscopic examination and primary repair of the diaphragm injury through a thoracotomy under general anesthesia. A trauma team incidentally found traumatic diaphragm injury that would be easy to miss on routine examination and subsequently successfully managed the injury via surgical repair of the injured diaphragm without complication.(Trauma Image Proced 2016(1):23-25)