A 30-year-old man stabbed in the left lower chest just below the costal margin presents two days later with dyspnoea. Examination reveals reduced breath sounds and audible bowel sounds over the left hemithorax. Chest radiograph shows a nasogastric tube coursing above the left diaphragm with its tip in the left chest. The most likely diagnosis is:
- A Left haemothorax with gastric dilatation
- B Tension gastrothorax secondary to congenital eventration
- C Left lower lobe consolidation with paralytic ileus
- D Traumatic left diaphragmatic rupture with herniation of the stomach ✓
Explanation
Penetrating wounds below the nipple line anteriorly or the tip of the scapula posteriorly can injure the diaphragm. Left-sided rupture is three times more common than right because the liver shields the right hemidiaphragm. Herniated stomach produces bowel sounds in the chest, and the pathognomonic finding is a nasogastric tube seen curling into the hemithorax on radiograph, confirming intrathoracic stomach. Eventration is congenital, lacks trauma history, and does not contain a misplaced nasogastric tube. Repair is operative, usually via the abdomen in the acute setting.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.