Abstract：
UNASSIGNED: We are reporting a case of a delayed hepatothorax due to a right-sided diaphragmatic rupture 13 years after a blunt trauma due to a motor vehicle accident, who presented as isolated gastritis without any type of respiratory symptomatology.
METHODS: Patient refers that his symptoms remained refractory to medical treatment and had gotten worse over time. Chest wall inspection showed asymmetric thoracic expansion and a decreased movement of right hemithorax when compared to the left. Cardiorespiratory auscultation was significant for growling sounds on the right second intercostal space and reduction of breath sounds on the right lower lobe region of the lung when compared to the left side.
UNASSIGNED: Thoracotomy was indicated since patient presented late. Meanwhile, laparotomy would have been appropriate if the patient had presented immediately after trauma. After the procedure, the patient presented in great condition and all the gastrointestinal symptoms associated with the traumatic diaphragmatic hernia had resolved. We propose that the absence of respiratory symptoms in our patient could be due to the progressive adaptation of small, cumulative changes in decreasing breathing capacity through time.
CONCLUSIONS: A case like ours has not been reported in the literature and clinicians should take this case report into consideration when suspecting a possible diagnosis of a delayed traumatic diaphragmatic hernia that may be complicated by a hepatothorax. We recommend maintaining a high index of clinical suspicion for hepatothorax due to delayed traumatic diaphragmatic hernia for all patients with a history of trauma.
METHODS: Patient refers that his symptoms remained refractory to medical treatment and had gotten worse over time. Chest wall inspection showed asymmetric thoracic expansion and a decreased movement of right hemithorax when compared to the left. Cardiorespiratory auscultation was significant for growling sounds on the right second intercostal space and reduction of breath sounds on the right lower lobe region of the lung when compared to the left side.
UNASSIGNED: Thoracotomy was indicated since patient presented late. Meanwhile, laparotomy would have been appropriate if the patient had presented immediately after trauma. After the procedure, the patient presented in great condition and all the gastrointestinal symptoms associated with the traumatic diaphragmatic hernia had resolved. We propose that the absence of respiratory symptoms in our patient could be due to the progressive adaptation of small, cumulative changes in decreasing breathing capacity through time.
CONCLUSIONS: A case like ours has not been reported in the literature and clinicians should take this case report into consideration when suspecting a possible diagnosis of a delayed traumatic diaphragmatic hernia that may be complicated by a hepatothorax. We recommend maintaining a high index of clinical suspicion for hepatothorax due to delayed traumatic diaphragmatic hernia for all patients with a history of trauma.
摘要：
UNASSIGNED：我们正在报告一例由于机动车事故造成的钝性外伤13年后，右侧膈肌破裂引起的延迟性肝胸，表现为孤立性胃炎，没有任何类型的呼吸道症状。
方法：患者是指他的症状仍然难以治疗，并且随着时间的推移变得更糟。与左侧相比，胸壁检查显示不对称的胸部扩张和右侧半胸部的运动减少。与左侧相比，心肺听诊对右侧第二肋间空间的咆哮声音和右侧下叶区域的呼吸声音减少具有重要意义。
UNASSIGNED：由于患者就诊时间较晚，因此需要进行开胸手术。同时,如果患者在创伤后立即出现，剖腹手术是合适的。手术后,患者病情良好，与创伤性膈疝相关的所有胃肠道症状均已缓解。我们认为，我们的病人没有呼吸道症状可能是由于小，随着时间的推移，呼吸能力下降的累积变化。
结论：像我们这样的病例尚未在文献中报道，临床医生在怀疑可能诊断为迟发性创伤性膈疝时，应考虑该病例报告。对于所有有外伤史的患者，由于延迟的创伤性膈疝，我们建议保持对肝胸的高临床怀疑指数。
方法：患者是指他的症状仍然难以治疗，并且随着时间的推移变得更糟。与左侧相比，胸壁检查显示不对称的胸部扩张和右侧半胸部的运动减少。与左侧相比，心肺听诊对右侧第二肋间空间的咆哮声音和右侧下叶区域的呼吸声音减少具有重要意义。
UNASSIGNED：由于患者就诊时间较晚，因此需要进行开胸手术。同时,如果患者在创伤后立即出现，剖腹手术是合适的。手术后,患者病情良好，与创伤性膈疝相关的所有胃肠道症状均已缓解。我们认为，我们的病人没有呼吸道症状可能是由于小，随着时间的推移，呼吸能力下降的累积变化。
结论：像我们这样的病例尚未在文献中报道，临床医生在怀疑可能诊断为迟发性创伤性膈疝时，应考虑该病例报告。对于所有有外伤史的患者，由于延迟的创伤性膈疝，我们建议保持对肝胸的高临床怀疑指数。
