Blunt traumatic rupture of the right diaphragm is very rare, and the subsequent development of diaphragmatic hernia is a serious complication. We herein report two cases of right diaphragmatic injury diagnosed by plain chest X-ray and multiplanar reformation of multi-detector law computed tomography (MPR-MDCT). We performed transthoracic repair of the diaphragm, and the post-operative course was uneventful in both cases. MPR-MDCT was useful for the diagnosis of right diaphragmatic injury.
A 54-year-old woman was struck from behind while driving. Her vital signs were stable on admission to the first hospital, but chest CT demonstrated hematoma surrounding the brachiocephalic artery, in addition to facial bone and pelvic fractures. She was transported to our hospital and an emergency operation was performed. The tunica intima was disrupted at a proximal portion of the brachiocephalic artery, and an aneurysm had formed. An extracorporeal circuit was created from the ascending aorta to the right common carotid artery using a temporary shunt tube, and artificial vessel replacement of the brachiocephalic artery was safely performed while clamping the right common carotid artery and the right subclavian artery. The patient was discharged without any neurological deficit. The surgical strategy of revascularizing while maintaining cerebral perfusion employed in this case is useful for traumatic injury to the brachiocephalic artery with poor collaterals.