19 year-old male s/p high-speed MVC with hypotension and diminished breath sounds on left. Diagnosis?
Answer: Diaphragmatic rupture (Note position of NG tube on image below).
·Uncommon; less than 1% of all traumatic injuries
·Diagnosis may be obvious on CXR (as in example) or subtle (e.g., diaphragmatic elevation, basilar atelectasis, etc.)
·Requires a high-index of suspicion because delayed diagnosis increases the risk of abdominal organ herniation or strangulation.
·Mortality depends on the mechanism and presence of associated injuries; mortality is highest for blunt injuries.
Bhavnagri S, et al. When and how to image a suspected broken rib. Cleveland Clinic J Med. 2009;76(5):309.
Williams M, et al. Predictors of mortality in patients with traumatic diaphragmatic rupture and associated thoracic and/or abdominal injuries. Am Surg. 2004;70(2):157.
National Trauma Data Base. American College of Surgeons 2000-2004.
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