'Delayed' Right Diaphragmatic Rupture Because of Positive Pressure Mechanical Ventilation

摘要

A 21 year-old man, who was an unrestrained passenger in a high-speed motor vehicle crash with 2 fatalities and a prolonged extrication, was brought to the emergency department at Harborview Medical Center. The patient was intubated after arrival because of hemodynamic instability. The initial chest radiograph (CXR) showed a slight contour abnormality of the right hemidiaphragm (Fig 1). Diagnostic peritoneal lavage was grossly and microscopically negative for blood but did contain chyle, so he was taken for an emergent exploratory laparotomy. The CXR normalized by the time the patient was admitted to the intensive care unit and remained as such while the patient was mechanically ventilated (Fig 2).