Traumatic Intrapericardial Diaphragmatic Herniation

A 61-year-old man was referred to our hospital after a high impact motor vehicle accident. A full body CT scan revealed a cranial subdural hematoma and multiple fractures of the axial and appendicular skeleton (not shown), as well as a retrosternal hematoma. Because of steadily decreasing hemoglobin and hematocrit levels on day 2, a repeat thoracoabdominal CT scan was performed, but active bleeding was not found. On day 7, sudden desaturation and increased drain output from the nasogastric tube prompted for a repeat thoraco-abdominal CT scan.