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Delayed Recognition of Diaphragmatic Rupture in a Patient Receiving Mechanical Ventilation

Yvonne M. Carter1, Riyad C. Karmy-Jones1 and Eric J. Stern2

1 Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Ave., Box 359728, Seattle, WA 98104-2499.
2 Department of Radiology, Harborview Medical Center, University of Washington School of Medicine, Seattle WA 98104-2499.



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  		Fig. 1A. —57-year-old man with delayed diaphragm rupture. Initial chest radiograph shows endotracheal intubation and nonspecific opacification of left lower lobe with silhouetting of left diaphragm believed to represent atelectasis.

 


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  		Fig. 1B. —57-year-old man with delayed diaphragm rupture. Follow-up chest radiograph on fourth hospital day after positive end-expiratory pressure was removed. Again note dense opacification of left lower lung, but now with interval malpositioning of nasogastric tube (arrow) overlying thorax, consistent with diaphragmatic rupture and gastric herniation.

 

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