Motorbike accident. Hypotensive. Hypoxic.
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The appearances of the nasogastric tube tip suggested that there may be rupture of the left hemidiaphragm with the stomach and other intra-abdominal contents now lying within the left hemithorax. There is mediastinal shift to the right. The exact position of the left hemidiaphragm is difficult to be certain of.
Multiple rib fractures are identified with extensive air space opacification noted. No definite pneumothorax can be identified.
Patient proceeded to trauma laparotomy and diaphragmatic rupture was confirmed.
Diaphragmatic rupture is a rare consequence of blunt trauma but recognition is important as it carries significant mortality and morbidity.