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Park, Kim, Kim, Lee, Kim, Hyun, and Shin: Delayed Diagnosis of a Traumatic Diaphragmatic Injury
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(3): 241-245.

Published online: 31 March 2009

DOI: https://doi.org/10.4046/trd.2009.66.3.241

Delayed Diagnosis of a Traumatic Diaphragmatic Injury

Seon-Wook Park, M.D.1, Cheol-Hong Kim, M.D.1, Ji-Youn Kim, M.D.1, Seung-Hwa Lee, M.D.1, Young-Wook Kim, M.D.1, In-Gyu Hyun, M.D.1, Ho-Seung Shin, M.D.2

1Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

2Department of Thoracic and Cardiovascular Surgery, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: Cheol-Hong Kim, M.D. Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 94-200, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-719, Korea. Phone: 82-2-2639-5787, Fax: 82-2-2677-9756, kimch2002@hallym.or.kr

Received 17 November 2008       Accepted 10 March 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Traumatic diaphragmatic rupture is uncommon, but requires a prompt diagnosis and repair. Diaphragmatic injury is most commonly associated with automobile accidents. The diagnosis is difficult and may be delayed because there are no specific symptoms, signs, or radiographic studies that are pathognomic for diaphragmatic injury. The most important factor in the diagnosis is a high suspicion and the use of proper diagnostic studies. We report a case involving the delayed presentation of diaphragmatic rupture in a 54 year old man, requiring surgical repair 12 days following multiple blunt trauma. It should be noted that early recognition for diaphragmatic injury is important in patients with multiple trauma to avoid the potential fatal complications.

Keywords: Diaphragm, Injury, Trauma

Figures and Tables

Figure 1
Chest radiographs showing multiple rib fractures and increased opacity in left lower lung (A: admission), and some rib calluses and cleared left lower lung opacity (B: 1 year after discharge).
trd-66-241-g001
Figure 2
Chest computed tomography showing rib fracture and pleural effusion of left lung (A: admission), and rib fracture, interrupted line of diaphragm (white arrow) and herniated spleen in left hemithorax (B: follow-up on the 12th hospital day).
trd-66-241-g002
Figure 3
Operative findings showed diaphragmatic rupture (10×5 cm sized defect [black arrow] along the posterior lateral border of left diaphragm) and the herniation of stomach fundus, omentum and spleen, into the thoracic cavity through the ruptured diaphragmatic opening.
trd-66-241-g003

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