The Undrainable Post-Traumatic Right Massive Haemothorax
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 7
Abstract
Traumatic right diaphragmatic hernias are uncommon and frequently missed. We present an interesting case of a patient initially thought to have clinical and radiological signs of a right massive haemothorax that was actually a large right diaphragmatic hernia, which was managed surgically.Diaphragmatic injuries related to thoraco-abdominal trauma are rare, with an incidence of 0.8-5% [1]. Due to coexisting injuries, small herniation and the silent nature of diaphragmatic ruptures, the diagnosis can sometimes be missed in the acute phase, and may present later with obstructive symptoms due to incarcerated organs in the diaphragmatic defect [2]. Right sided diaphragmatic herniation is infrequent due to protection by the liver and the congenitally stronger, right hemi-diaphragm [1,3]. This case report discusses an adult patient who was diagnosed to have right-sided diaphragmatic rupture and hepatothorax, acutely following a road traffic accident.A 26 year old man was admitted to accident and emergency following a road traffic accident. On admission the patient was distressed, dyspnoeic and hypotensive. Initial primary survey revealed a right massive haemothorax, a pelvic fracture, a right femoral fracture and a left tibial fracture (Figure 1). Despite initial resuscitation and chest drain insertion the patient remained in respiratory distress with a puzzling and seemingly undrainable haemothorax. A placement of a second intercostal chest drain was queried, due to the position of the first drain ‘above the massive haemothorax. Before this, a review of the gentleman was carried out to consolidate or refute the diagnosis of a massive haemothorax.
Authors and Affiliations
Anthony Adimonye, Arthur Cotton, James Jenkins
Keywords
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- EP ID EP583220
- DOI 10.26717/BJSTR.2017.01.000595
- Views 168
- Downloads 0
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