Abstract
IntroductionDiaphragmatic ruptures are a rare condition with an incidence of about 0.8-5.8% after blunt thoracoabdominal trauma. Right sided ruptures accompanied by a displacement of intraabdominal organs are very uncommon and account for approximately 5-19% of all diaphragmatic ruptures. The majority of diaphragmatic ruptures are based on high speed motor vehicle accidents (MVA) and high falls.Case presentationHerein we report a case of a 58-year old woman after a high-speed MVA with a right-sided diaphragmatic rupture and displacement of the liver into the thorax, mimicking a pleural effusion.ConclusionDue to the low incidence and frequently present masking injuries, diagnosis is difficult and virtually always delayed. Thus, a high index of suspicion is important in cases of blunt thoracoabdominal trauma, as the 24 h mortality-rate of a right sided diaphragmatic rupture is up to 30%. In these situations a spiral CT-scan is the diagnostic tool of choice. Surgical intervention using an abdominal approach via a hockey-stick shaped incision is necessary even for small tears. Part of the polytrauma management following high speed MVAs is a critical review of the radiologic imaging.
Highlights
Diaphragmatic ruptures are a rare condition with an incidence of about 0.8-5.8% after blunt thoracoabdominal trauma
The majority of diaphragmatic ruptures are based on high speed motor vehicle accidents (MVA) and high falls
Case presentation: we report a case of a 58-year old woman after a high-speed MVA with a right-sided diaphragmatic rupture and displacement of the liver into the thorax, mimicking a pleural effusion
Summary
Diaphragmatic ruptures are a rare condition with an incidence of about 0.8-5.8% after blunt thoracoabdominal trauma [1,2,3]. We present a case of a right sided diaphragmatic rupture with herniation of the entire right hepatic lobe into the thorax after a high-speed MVA, initially misinterpreted as a pleural effusion. Case presentation After a high speed MVA, a 58-year old white German woman was initially admitted to a primary care hospital in northern Germany. She was conscious and accessible but suffered from severe pain in the legs and the pelvis as well as from acute dyspnea. After this maneuver we were able to relocate the liver into the abdomen Throughout this part of the operation meticulous care was taken on the preservation of the vena cava. There were no further thoracic or abdominal complications during hospital stay
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