Hepatothorax after right-sided diaphragmatic rupture mimicking a pleural effusion: a case report

Diaphragmatic ruptures are a rare condition with an incidence of about 0.8-5.8% after blunt thoracoabdominal trauma. Right sided ruptures accompanied by a displacement of intraabdominal organs are very uncommon and account for approximately 5-19% of all diaphragmatic ruptures. The majority of diaphragmatic ruptures are based on high speed motor vehicle accidents (MVA) and high falls.

Herein we report a case of a 58-year old woman after a high-speed MVA with a right-sided diaphragmatic rupture and displacement of the liver into the thorax, mimicking a pleural effusion.

Due to the low incidence and frequently present masking injuries, diagnosis is difficult and virtually always delayed. Thus, a high index of suspicion is important in cases of blunt thoracoabdominal trauma, as the 24 h mortality-rate of a right sided diaphragmatic rupture is up to 30%. In these situations a spiral CT-scan is the diagnostic tool of choice. Surgical intervention using an abdominal approach via a hockey-stick shaped incision is necessary even for small tears. Part of the polytrauma management following high speed MVAs is a critical review of the radiologic imaging.