Decreased Breathing Sounds Despite Chest Drain after Trauma

摘要

Unilateral decreased breathing sounds on auscultation following injuries to the thorax are primarily due to hemato-/pneumothorax especially in the presence of ipsilateral rip fractures. The present case report illustrates a trauma patient with rip fractures und unilateral decreased breathing sounds on auscultation after a frontal road traffic collision. At scene a needle decompression and a chest drain were inserted after intubation but without clinical improvement. Unilateral decreased breathing sounds persisted along with decreased oxygen saturation. Emergency x-ray imaging upon ER admission revealed the presence of an enterothroax. This is a rare injury with an incidence of 0.8-1.6% after blunt thoracic trauma. Surgical procedures relocate displaced abdominal organs from the thorax into the abdomen and the diaphragm is reconstructed including mesh grafting. Small injuries of diaphragm are often missed and diagnosed with delay if secondary complications occur such as obstruction (ileus).