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Kenneth J. Woodside, MD; John A. Daller, MD, PhD
From the Department of Surgery, University of Texas Medical Branch, Galveston.

Arch Surg. 2002;137:971-972.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

A 54-YEAR-OLD restrained driver was involved in a rollover motor vehicle crash and came to the emergency department complaining of shortness of breath, left pleuritic chest pain, and back pain. Her vital signs included the following: heart rate, 73 beats/min; blood pressure, 172/102 mm Hg; and respirations, 18/min. Although the patient's breath sounds were decreased on the left side, her oxygen saturation was 95% using a 100% oxygen non–rebreather face mask. The patient's chest x-ray film is shown in Figure 1.

What Is the Diagnosis?

A. Hemopneumothorax

B. Hiatal hernia

C. Diaphragmatic rupture

D. Pulmonary contusion.

Answer: Diaphragmatic Rupture

Figure 1. Chest radiograph after placement of the nasogastric tube, demonstrating coiling of the tube in the chest.

Traumatic diaphragmatic rupture from a blunt mechanism is a relatively uncommon injury that occurs when there is a sudden increase in the pleuroperitoneal pressure gradient against a contracted diaphragm.¹ . . . [Full Text of this Article]

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