A 38-year-old man involved in a frontal collision presents with left-sided chest pain and increasing dyspnoea. Breath sounds are diminished at the left base and bowel sounds are audible over the lower left hemithorax. Chest radiograph shows a nasogastric tube curling into the left hemithorax above an apparent elevated hemidiaphragm. The most likely diagnosis is:

• A Left lower lobe collapse
• B Left haemothorax
• C Left diaphragmatic rupture with herniation of stomach into the thorax ✓
• D Hiatus hernia unrelated to trauma

Explanation

Blunt diaphragmatic rupture follows sudden transmission of intra-abdominal pressure and occurs far more commonly on the left because the liver buttresses the right dome. Bowel sounds in the chest and a nasogastric tube seen coiling into the hemithorax are pathognomonic clues. Haemothorax would show dullness rather than bowel sounds and the tube course excludes it. Treatment is operative repair, classically via the abdomen in acute cases, since these defects rarely heal spontaneously and carry a risk of visceral strangulation if missed.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.