Right atrial compression secondary to diaphragmatic rupture and liver displacement: A case report

Abstract

Background

Diaphragmatic rupture, a rare condition, can be categorized as traumatic or nontraumatic in origin. Traumatic diaphragmatic rupture (TDR) occurs in 0.8–5 % (Rossetti et al., 2005) of cases involving high-impact blunt or penetrating trauma to the chest or abdomen. Nontraumatic etiologies include congenital defects, acute elevations in intra-abdominal pressure, endometriosis, diaphragmatic abscess, or diaphragmatic eventration. Early recognition and management are critical due to its potential complications, including obstructive shock and organ herniation (Rossetti et al., 2005; Keyes et al., 2024).

Case report

We report a case of a 70-year-old woman presenting to the emergency department (ED) following cardiac arrest. Imaging revealed a diaphragmatic rupture with herniation of the liver into the thoracic cavity, causing right atrial compression and obstructive shock. Definitive management required transfer to a center with specialized cardiothoracic services for potential surgical repair after hemodynamic stabilization.

Why should an emergency physician be aware of this

Diaphragmatic rupture is an uncommon diagnosis that can mimic other conditions, delaying lifesaving treatment. Prompt imaging with CT is essential for accurate diagnosis, as chest radiography has low sensitivity. Emergency physicians must maintain a high index of suspicion in cases of undifferentiated shock to avoid fatal outcomes.