Presentation
Major trauma. MVA car vs truck. Hypotensive.
Patient Data
Right hemidiaphragmatic rupture with herniation of liver into the chest and a large hepatic laceration with hematoma and likely active bleeding in segment VII.
Right hemopneumothorax. Left pneumothorax. Bilateral rib fractures.
Reduced enhancement of the anterior lower pole of the right kidney with likely dissection of one of the right renal arteries.
Splenic laceration.
Duodenal appearance suspicious for bowel injury.
L1-5 transverse process fractures and extensive pelvic fractures. Left sacral ala fracture with possible common, internal and external left iliac vein injury.
Case Discussion
Diaphragmatic rupture is much more common on the left due to the protective effect of the liver on the right.
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