A Unique Presentation of Right Diaphragmatic Rupture Associated with Pneumoperitoneum: A Case Report

橫隔膜破裂的診斷常見於有胸腹部創傷病史、肺部受壓迫相關症狀及異常放射學檢查發現的病人。然而，橫隔膜破裂在早期因症狀或症候不具特異性或不明顯時，可能被錯失過。部份橫隔膜破裂病人也可能延遲表現，特別發生於右側。本文報告急診室一位男性於二星期前有胸腹部鈍傷病史，臨床上有腹痛及呼吸窘迫表現。胸部X光發現右橫隔膜上升及肺部下野模糊，電腦斷層發現腹膜腔積氣且無明顯橫隔膜破裂的放射學診斷證據。考慮腹部中空臟器破裂下，隨即剖腹探查手術，發現右橫隔膜破裂及同側肺臟破裂。在缺乏典型症狀、症候及放射學檢查發現下，但有胸腹部創傷病史及腹膜腔積氣病患，橫隔膜破裂應被列入鑑別診斷

關鍵字

橫隔膜破裂；胸腹部鈍傷；腹膜腔積氣

並列摘要

Diaphragmatic rupture (DR) is usually diagnosed in patients with a history of thoraco-abdominal trauma. Symptoms are related to lung compression and abnormal radiologic findings. However, DR may be missed initially when the symptoms and signs are nonspecific or subtle. Delayed onset of DR, especially on the right side, may occur in some patients. We report a patient presenting with abdominal pain and dyspnea two weeks after blunt thoraco-abdominal trauma. The chest radiograph revealed opacities over the lower lung zones and elevation of the diaphragm on the right side. Computed tomography demonstrated extensive pneumoperitoneum without evidence of radiologic signs of DR. An exploratory laparotomy was performed under the impression of hollow organ perforation. Right-sided DR associated with ipsilateral rupture of the lung was eventually diagnosed. DR should be included in the differential diagnosis in patients with a history of thoraco-abdominal trauma and pneumoperitoneum even if there are no classic symptoms, signs or radiological findings.

並列關鍵字

diaphragmatic rupture ； blunt thoraco-abdominal injury ； pneumoperitoneum

國際替代計量

A Unique Presentation of Right Diaphragmatic Rupture Associated with Pneumoperitoneum: A Case Report

全文下載

主題瀏覽