A 56-year-old man was transported to our trauma centre after extraction from a high-energy car versus tree crash. At physical examination, the patient was intubated and had a chest drain with an oxygen saturation of 95%, and no circulatory problems. In addition, there were clinically evident fractures of the femur and forearm.

Participation

Moderate quality X-ray due to obesity and moderate inspiration. Sternum wires and artificial aortic valve. Presence of a chest drain and orotracheal tube. No clear delineation of the left hemidiaphragm with opacification of the left lung suggesting left diaphragmatic rupture and/or pulmonary contusion. Notable cranial position of the stomach tube suggesting left diaphragmatic rupture. Abnormal mediastinum possibly caused by an aortic rupture or due to inadequate inspiration. Rib fractures.

Requirements

(1) MDCT confirmed the presence of an aortic valve prosthesis, rib fractures, an (intraparenchymatously positioned) chest drain (not shown), atelectasis, and demonstrated a diaphragmatic rupture with herniation of the bowel and the spleen into the thoracic cavity… … (2,3) diaphragmatic rupture (arrows) with herniation of the bowel and the spleen into the thoracic cavity (arrows). The presence of a fatty mediastinum on CT explained the presence of a widened mediastinum on chest X-ray.

Extraexaminations

No EXTRA EXAMINATIONS for this particular case.

Requirements

Blunt trauma patient with: diaphragmatic rupture with herniation of intact hollow and parenchymatous organs into the thoracic cavity which was confirmed at emergency laparatomy. Associated injuries: fractures of several ribs, the pelvis, the femur and forearm

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