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CME QUIZ
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 47-48

Posttraumatic diaphragmatic hernia


Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission22-Jul-2019
Date of Acceptance02-Aug-2019
Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Joseph Joshua Vijay
Department of Emergency Medicine, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_26_19

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How to cite this article:
Vijay JJ, Prabhakar Abhilash KP. Posttraumatic diaphragmatic hernia. Curr Med Issues 2019;17:47-8

How to cite this URL:
Vijay JJ, Prabhakar Abhilash KP. Posttraumatic diaphragmatic hernia. Curr Med Issues [serial online] 2019 [cited 2019 Sep 17];17:47-8. Available from: http://www.cmijournal.org/text.asp?2019/17/2/47/265823

A 38-year-old gentleman presented to our emergency department (ED) with complaints of abdominal pain, breathlessness, fever, and inability to pass stools and flatus for the past 3 days.

Five months back, he had a history of blunt trauma to the left side of the chest sustaining rib fractures which was managed conservatively.

On arrival to ED, he was alert, conscious, and oriented with a heart rate of 110/min, blood pressure of 90/60 mmHg, and respiratory rate of 36/min and holding a room air saturation of 90%.

On inspection, he had decreased movement of the left-sided chest wall compared to the right side. Trachea was deviated to the right, and on percussion, dullness was heard on the left side. On auscultation, breath sounds were absent on the left side. Normal vesical breath sounds were heard on the right side.

Abdomen was scaphoid; tenderness was present over the epigastric region and left hypochondrium. Other systemic examinations were not significant.

Shown here is the X-ray [Figure 1].
Figure 1: Chest X-ray posteroanterior view.

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  Question Top


What is your diagnosis?


  Answer Top


X-ray chest showed features of:

  • Distortion of the diaphragmatic margin
  • Elevated hemi-diaphragm; left more than right
  • Bowel loops in the lung field.[1]


Computed tomography of the thorax and abdomen showed features suggestive of:

  • Left sided diaphragmatic hernia with a gastric volvulus
  • Part of the transverse colon herniating into the left hemithorax causing compressive atelectasis of the left lower and upper lobes causing mediastinal shift.


No evident gastric wall pneumatosis, free air under the diaphragm, or free fluid in the hernia sac was observed. The nasogastric tube is noted to reach up to the gastroesophageal junction.

Diagnosis is diaphragmatic hernia posttraumatic.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging 2011;2:281-95. doi:10.1007/s13244-011-0072-9  Back to cited text no. 1
    


    Figures

  [Figure 1]



 

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