EC Clinical and Medical Case Reports

Traumatic diaphragmatic rupture following a penetrating thoracic injury may be overlooked because the diaphragmatic defect can be small and the initial clinical findings nonspecific. We report the case of a 20-year-old man admitted following a stab wound to the left lower posterior thorax. The patient was tachypneic, with a normal heart rate and a Glasgow Coma Scale score of 15/15. The CT scout image showed diffuse opacification of the left hemithorax and an enteric tube coiling above the expected level of the left hemidiaphragm. Contrast-enhanced thoracoabdominal CT demonstrated a left diaphragmatic defect with intrathoracic gastric herniation. Coronal reformatted images revealed focal waist-like constriction of the stomach at the diaphragmatic defect, producing the characteristic collar or hourglass sign. Associated findings included a left pneumothorax, hemothorax, pulmonary contusions, and compression of the residual left lung. The diagnosis of acute traumatic left diaphragmatic rupture with intrathoracic gastric herniation was established. Surgical treatment consisted of reduction of the stomach into the abdominal cavity and primary suture repair of the diaphragmatic defect. This case emphasizes the importance of multidetector CT and multiplanar reformations for the early diagnosis of diaphragmatic injury after penetrating thoracic trauma.

Keywords: Traumatic Diaphragmatic Rupture; Penetrating Thoracic Trauma; Gastric Herniation; Collar Sign; Hourglass Sign; Com- puted Tomography

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