Traumatic Intrapericardial Diaphragmatic Herniation

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Radiology

Background:

• A 61-year-old male sustained severe injuries, including cranial subdural hematoma, skeletal fractures, and a retrosternal hematoma, from a high-impact motor vehicle accident.
• Initial assessment revealed significant trauma, necessitating comprehensive imaging and monitoring.
• Hemodynamic instability, indicated by decreasing hemoglobin and hematocrit, suggested ongoing complications.

Purpose of the Study:

• To investigate the cause of delayed desaturation and increased nasogastric tube output in a trauma patient with a retrosternal hematoma.
• To evaluate the utility of serial thoracoabdominal CT scans in identifying occult bleeding post-trauma.

Main Methods:

• Serial thoracoabdominal computed tomography (CT) scans were utilized for diagnostic imaging.
• Clinical parameters including hemoglobin, hematocrit, and nasogastric tube output were closely monitored.
• Management involved intensive care and surgical consultation.

Main Results:

• Initial CT scans identified a retrosternal hematoma but no active bleeding.
• Despite initial stabilization, the patient experienced delayed complications including sudden desaturation and increased nasogastric tube output on day 7.
• Repeat thoracoabdominal CT scans were crucial in reassessing the patient's condition and guiding management.

Conclusions:

• Retrosternal hematomas can present a diagnostic challenge, with potential for delayed complications in trauma patients.
• Serial CT imaging is valuable for detecting occult or re-emerging hemorrhage in critically ill trauma patients.
• Multidisciplinary management is essential for optimizing outcomes in complex trauma cases.