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Diagnose on Sight: Shortness of Breath

shortness of breathCase: 55-year-old restrained driver is reporting severe shortness of breath and right sided chest pain after a high-speed motor vehicle collision. Her respiratory rate is 26 breaths/min and her oxygen saturation is 96% on a 15-liter non-rebreather. She has decreased breath sounds on the right, epigastric tenderness, and an abdominal seatbelt sign. What is the diagnosis?

Poll Results

Answer
1.
Fajolu O. Traumatic diaphragmatic hernia. J Natl Med Assoc. 1984;76(12):1163-1164. [PubMed]
2.
Dwari A, Mandal A, Das S, Sarkar S. Delayed presentation of traumatic diaphragmatic rupture with herniation of the left kidney and bowel loops. Case Rep Pulmonol. 2013;2013:814632. [PubMed]
3.
Vilallonga R, Pastor V, Alvarez L, Charco R, Armengol M, Navarro S. Right-sided diaphragmatic rupture after blunt trauma. An unusual entity. World J Emerg Surg. 2011;6:3. [PubMed]
4.
Kuppusamy A, Ramanathan G, Gurusamy J, Ramamoorthy B, Parasakthi K. Delayed diagnosis of traumatic diaphragmatic rupture with herniation of the liver: a case report. Ulus Travma Acil Cerrahi Derg. 2012;18(2):175-177. [PubMed]
5.
Meyers B, McCabe C. Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg. 1993;218(6):783-790. [PubMed]
Sarah G. Sifuentez MD

Sarah G. Sifuentez MD

Senior Resident
UCSF-Fresno Emergency Medicine Residency Program
Sarah G. Sifuentez MD

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Saleen Manternach, MD FACEP

Saleen Manternach, MD FACEP

Assistant Clinical Professor of Emergency Medicine
UCSF-Fresno
Saleen Manternach, MD FACEP

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Danielle Campagne, M.D. FACEP

Danielle Campagne, M.D. FACEP

Associate Professor of Clinical Emergency Medicine
UCSF-Fresno
Danielle Campagne, M.D. FACEP

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Jeff Riddell, MD

Jeff Riddell, MD

ALiEM Assistant Editor
Diagnose on Sight series;
Medical Education Research Fellow
University of Washington / Harborview Medical Center
Jeff Riddell, MD

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