A 35-year-old woman sustains blunt abdominal trauma in a fall from height. She is haemodynamically stable. A chest radiograph shows the nasogastric tube coiled within the left hemithorax and bowel loops above the left hemidiaphragm. The most likely diagnosis is:

• A Congenital Bochdalek hernia unmasked by the trauma
• B Left lower lobe pulmonary contusion with atelectasis
• C Oesophageal rupture with mediastinitis
• D Left diaphragmatic rupture with herniation of stomach and bowel ✓

Explanation

Blunt diaphragmatic rupture occurs more commonly on the left because the liver buttresses the right hemidiaphragm. Herniated stomach or colon in the chest may be seen as apparent elevation of the hemidiaphragm, and a nasogastric tube coiling into the hemithorax is a classic confirmatory sign. These hernias do not spontaneously reduce, and repair is operative, usually via the abdomen in acute cases.

Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.