Trauma, Diaphragmatic Rupture

Postponed

Step 1: View clinicals

A 40 year old man presents with progressively worsening exertional dyspnea for 6 months. He is otherwise asymptomatic. He gives a history of blunt abdominal trauma following a motor vehicle accident 4 years ago. An emergency laparotomy was performed, during which a laceration of the liver was detected. His medical history is otherwise unremarkable. He does not smoke and there is no family history of malignancies or cardiac or respiratory diseases.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 8,500/mm3 Neutrophils: 70% Lymphocytes: 28% Hb: 13.1 g/dL Hct: 40% Platelets : 331,000/mm3

X-Ray Chest

The x-ray shows unilateral elevation of the right hemidiaphragm. The right lung shadow appears normal otherwise. The left lung shadow, hemidiaphragm and cardiac silhouette appear normal, while the trachea is central.

CT chest and Abdomen

The CT scan reveals a defect in the right diaphragm with intrathoracic herniation of the liver. Basal atelectasis of the right lung is noted.

ECG

The ECG appears normal.


Step 3: Select appropriate management

Nil Orally stat
Bronchodilators
Thoracic Surgery
Conservative management


Score: ★★☆