Rechtsseitige Zwerchfellruptur mit intrathorakaler Verlagerung des gesamten rechten Leberlappens

A case of rupture of the right hemidiaphragm resulting from blunt trauma with complete intrathoracic dislocation of the right hepatic lobe in a multiple trauma patient is presented. After a primary chest X-ray study had been interpreted as showing right-sided hemothorax, the thoracic drainage tube was accidentally placed into the liver. CT revealed a diagnosis of diaphragmatic rupture with intrathoracic liver dislocation. The liver was replaced and the extended dorsal diaphragmatic rupture was closed primarily via an abdominal approach. Problems of diagnosis and operative procedure in rare cases of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed. CT may be helpful in the differential diagnosis of pulmonary contusions, hemothorax and diaphragmatic disruptions with intrathoracic herniation of intra-abdominal organs.