Traumatic Rupture of Diaphragm and Chest Wall Secondary to COPD Exacerbation

摘要

A 67-year-old woman with history of COPD and tobacco abuse disorder presented to the ED for sudden onset of left upper quadrant pain after a forceful productive cough with yellow sputum that she developed two days prior with nausea and shortness of breath with deep breathing and was admitted to surgery for evaluation. The patient was moderately dyspneic, with diminished breath sounds bilaterally and tenderness to palpation in the left upper quadrant. On physical examination on admission, there was tenderness to palpation and ec-chymosis noted on her left abdominal and chest wall. Chest radiography showed a suspected defect along the lateral aspect of the left hemidiaphragm, which was suspicious for diaphragmatic rupture that extended into the soft tissues of the left chest wall (Fig. 1). A subsequent CT scan showed a lateral left diaphragmatic rupture with herniation of the stomach through the defect and through an additional left chest wall defect between the seventh and eighth ribs (Fig. 2). Surgery consultation was requested for repair of the herniation of her stomach up through her chest and exiting her chest wall.