Abstract
Traumatic diaphragmatic rupture (TDR) cannot be excluded in patients receiving mechanical ventilation (MV). However, few reports have documented actual cases. We present the case of a 64-year-old man who was injured in a motorcycle accident who developed TDR, but the diagnosis was delayed because he needed MV due to an associated head injury. On admission, he was somnolent but did not need intubation. Radiological examinations showed left rib fractures and a subdural hematoma. A small mass was identified on the left diaphragm, though it could not be positively identified as TDR. One hour later, the patient's mental status deteriorated, and a craniotomy was performed. Postoperatively, the patient received MV. On hospital day 7, chest CT showed no abnormality. On day 20, MV was stopped. Serial chest radiographs done on the following 3 days showed no changes, but the day 23 radiograph revealed a stomach gas bubble in the left thoracic cavity. TDR was diagnosed and repaired surgically. After surgery, the admission coronal and 3-dimensional CT images were reformatted; the admission coronal CT clearly demonstrated the TDR. Furthermore, based on the day 7 CT scans in which no organ was incarcerated, a 3-dimensional CT of the ruptured diaphragm could be reconstructed. Coronal and 3-dimensional CT provide significant information of diaphragmatic rupture.
