# Pericardio-diaphragmatic rupture after blunt trauma: a case report

## TL;DR

A rare case of pericardio-diaphragmatic rupture after chest trauma is reported, highlighting the diagnostic challenge and successful surgical repair.

## Contribution

This case report adds to the limited literature on pericardio-diaphragmatic rupture and emphasizes the need for combined thoracoabdominal evaluation.

## Key findings

- A 70-year-old man had a large left diaphragmatic tear with bowel herniating into the pericardial sac.
- Median sternotomy was required for safe repair due to high tension and limited exposure.
- Postoperative imaging confirmed successful resolution of the hernia.

## Abstract

Pericardio-diaphragmatic rupture with intrapericardial herniation is a rare and potentially life-threatening complication of blunt thoracoabdominal trauma. Its diagnosis is challenging because pericardial involvement is often missed on imaging.

We present the case of a 70-year-old man who sustained blunt chest trauma in a motor vehicle collision. On admission, he was hemodynamically stable, and echocardiography demonstrated preserved left ventricular function (ejection fraction 59%) without pericardial effusion. Initial CT demonstrated multiple right rib fractures and pulmonary contusion. Repeat CT at our center revealed bilateral lower lobe atelectasis, small pleural effusions, and a bowel gas shadow anterior to the heart, suggestive of diaphragmatic rupture with intrapericardial herniation. Thoracoscopic exploration excluded right-sided injury; however, laparoscopic inspection identified a large left diaphragmatic tear (10 cm) with bowel and omentum herniating into the pericardial sac in direct contact with the epicardial surface. Due to limited exposure and high tension, the procedure was converted to median sternotomy for safe repair. Postoperative CT confirmed resolution of the hernia. The patient recovered uneventfully and remained asymptomatic at 3-month follow-up.

Pericardio-diaphragmatic rupture with intrapericardial herniation is rare and often underdiagnosed because of nonspecific clinical features and subtle imaging findings. Median sternotomy should be considered when minimally invasive repair is not feasible, and combined thoracoabdominal evaluation is crucial for diagnosis and management.