Right diaphragm rupture with extended traumatic dissection of the descending aorta.
A 45-year-old man, with severe thoracic injury from a motor accident, is reported with traumatic aortic dissection type B and projection of the liver into the thoracic cavity due to a large rupture of the right hemidiaphragm. The patient was successfully managed with endoluminal stent placement in the descending thoracic aorta, and right thoracotomy for the repair of the diaphragmatic hernia. His postoperative course was uneventful. The co-existence of aortic traumatic dissection and right diaphragmatic rupture in trauma patients has never been reported in the literature previously, to our knowledge. Furthermore, the initial x-ray examination findings advocated injury of the right hemithorax and could be misleading. The diagnostic assessment must have a high index of suspicion, whereas the surgical manipulation needs to be fast and targeted to the major thoracic injuries of the patient.
Zisis
Charalambos
C
Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece. chzisis@otenet.gr
Fragoulis
Sokratis
S
Kaskarelis
Ioannis
I
Dedeilias
Panayiotis
P
Bolos
Konstantinos
K
Bellenis
Ion
I
D000063:Accidents, Traffic; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000293:injuries*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006491:Hemothorax / Q000209:etiology; D006549:Hernia, Diaphragmatic, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008099:Liver; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D012253:Rib Fractures / Q000209:etiology; D012421:Rupture / Q000209:etiology / Q000601:surgery; D015607:Stents; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*