Blunt chest trauma with diaphragmatic laceration presenting as delayed hemothorax

Abstract

We report a case of delayed hemothorax resulted from diaphragmatic laceration after blunt chest trauma and its successful treatment. Initial chest X-ray and initial computed tomography (CT) scan revealed no hemothorax in this 19-year-old male with a stable hemodynamic condition although there were multiple contusion wounds with ecchymoses over the right chest wall, shoulder, back and right upper quadrant of abdomen. In the following day, he experienced progressive dyspnea and conscious disturbance. Massive hemothorax was verified through repeated chest X-ray and CT scan. A laceration wound about 3 cm in length with continuous oozing at the dome of the right hemidiaphragm was noted in emergent thoracotomy. The laceration was repaired, and the patient had an uneventful recovery after the surgery. We proposed that traumatic diaphragmatic injury should be considered in any patient who has sustained blunt trauma to the lower chest and upper abdomen regions, watchful observation and high index of suspicion are necessary.