A Case of Traumatic Hepatothorax

Abstract

Diaphragmatic injury from trauma is potentially fatal, and unfortunately initial diagnosis of traumatic diaphragmatic rupture is often missed in the acute setting. Radiographs may not show immediate herniation of abdominal contents indicating a defect in the diaphragm, and computed tomography is not always performed on trauma patients presenting without signs of abdominal pathology. Right-sided rupture occurs much less frequently than left-sided injuries, which is attributed to relative protection of the right hemi-diaphragm by the liver. The incidence of herniation of intra-abdominal contents is low, but when present can lead to severe morbidity from obstruction or strangulation of viscera. Because of the delay between diaphragmatic injury and diagnosis, patients often present with nonspecific symptoms, making identifying the correct diagnosis challenging. Definitive treatment involves surgical repair of the diaphragm, either through a thoracic or abdominal approach. We present the case of a patient found to have rightsided diaphragmatic rupture and hepatothorax two years after the inciting trauma.