Abstract
We report a case of traumatic right diaphragmatic hernia accurately diagnosed by multislice CT (MSCT). A 37-year-old man was injured in a traffic accident. On arrival, he was in shock. The initial chest X-ray and axial views of the trunk on MSCT demonstrated multiple right rib fractures, right lung contusion, right pneumo-hemothorax, peritoneal fluid collection, liver contusion, and pelvic fractures. Diaphragmatic hernia was not detected at that time. After placing a right chest tube, repeat chest X-ray demonstrated an abnormal oval contour of the right diaphragm. Multiplanar reformation views of the initial MSCT were reviewed. We accurately diagnosed right diaphragmatic hernia with characteristic “hump sign” and “band sign” configurations. Following hepatic and pelvic angiography with transcatheter arterial embolization of liver contusion, emergent laparotomy was performed. An 11 cm right diaphragmatic disruption was repaired. The patient was discharged with no complications on post operative day 30. Transient shock immediately following application of negative pressure thoracostomy tube suction to right hemithorthorax was suspected to reflect obstructive shock due to liver and diaphragm herniation compressing the right atrium. MSCT is quite useful for accurate diagnosis of traumatic right diaphragmatic hernia at an early stage.
