Images in...
Traumatic diaphragmatic rupture: a diagnostic challenge in the emergency department
Department of Emergency Medicine, Chi-Mei Medical Center, Yung-Kang City, Tainan, Taiwan
Correspondence to:
saab931103{at}yahoo.com.tw
A 24-year-old man presented to the emergency department after falling down from the fourth floor of a building on a construction site. Upon arrival he was alert, but dyspnoeic. The breath sounds over the left side of the chest were decreased. A chest radiograph was taken and revealed elevation of the left side of the hemidiaphragm (fig 1). Computed tomography of the chest was arranged to determine the severity of the lung injury (fig 2).
 View this figure (129K): Figure 1 Chest radiograph showing an arch-like curvilinear density indicating elevation of the left hemidiaphragm.
|
 View this figure (102K): Figure 2 CT scan showing herniation of intra-abdominal organs into the left thoracic cage.
|
The incidence rates of traumatic diaphragm rupture is between 0.8–1.6% of patients admitted because of blunt trauma.1 Left-sided rupture is more common than right-sided rupture (68.5% vs 24.2%).2 Hepatic protection of the right side, increased strength of the right hemidiaphragm, and weakness of the left hemidiaphragm at points of embryonic fusion all contribute to the predominance of left-sided diaphragmatic rupture.3 A delayed diagnosis of diaphragm rupture and its associated injuries to the chest wall, abdominal cavity, and pelvic cavity can result in life-threatening sequelae. Surgery should be performed as soon as the clinical diagnosis is made, either through the transabdominal approach or via thoracotomy.
This article has been adapted from Lee W-J, Lee Y-S. Traumatic diaphragmatic rupture: a diagnostic challenge in the emergency department Emergency Medicine Journal 2007;24:601
Competing interests: None declared.
- Ward, RE, Flynn, TC, & Clark, WP. Diaphragmatic disruption due to blunt abdominal trauma. J Trauma 1981; 21: 35–8.[Medline]
- Shah, R, Sabanathan, S, Mearns, AJ, et al. Traumatic rupture of diaphragm. Ann Thorac Surg 1995; 60: 1444–9.
[Abstract/Free Full Text] - Mansour, KA. Trauma to the diaphragm. Chest Surg Clin N Am 1997; 7: 373–83.[Medline]
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
-
Extract
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
Services
- Email this link to a friend
- Similar articles in this journal
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full text of all Editor's Choice articles and summaries of every article are free without registration
The full text of Images in ... articles are free to registered users
Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource
Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog
