Non-operative Management of a Diaphragmatic Hematoma: A Case Report

TL;DR

A 59-year-old woman with a diaphragmatic hematoma after a car accident was successfully managed without surgery, highlighting non-operative treatment as a viable option.

Contribution

Presents a novel case of non-operative management of a diaphragmatic hematoma in a critically injured patient.

Findings

Non-operative management was safely applied for a diaphragmatic hematoma with stable clinical and radiologic findings.

Accurate radiologic re-examination is crucial to avoid misdiagnosis of diaphragmatic hematomas as other injuries.

Non-operative treatment can reduce complications if closely monitored with follow-up imaging.

Abstract

Diaphragmatic hematomas are a rare complication of blunt trauma that are often overlooked due to the presence of high-acuity injuries. However, this injury can result in significant long-term complications if not managed appropriately. We present a 59-year-old female who developed a diaphragmatic crural hematoma following a motor vehicle accident. The patient arrived at the trauma bay unresponsive, hypertensive, requiring bag-valve mask ventilation, and with a Glasgow Coma Scale score of 3/15. On physical examination, the patient was found to have bilateral diminished breath sounds and was promptly intubated. Initial CT imaging of the patient demonstrated active contrast extravasation that was thought to be an adrenal hemorrhage but was actually a diaphragmatic hematoma upon re-examination. Although surgical intervention is a common approach for managing diaphragmatic injuries, non-operative management was chosen in this case due to the patient's stable condition and minimal evidence of active bleeding. This case highlights the possibility of non-operative management of diaphragmatic hematomas when used with accurate radiologic and clinical findings. When appropriate, non-operative management can reduce morbidity and mortality but requires careful radiologic follow-up to detect potential complications.

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