Postponed

A 40 year old man presents with progressively worsening exertional dyspnea for 6 months. He is otherwise asymptomatic.

He gives a history of blunt abdominal trauma following a motor vehicle accident 4 years ago. An emergency laparotomy was performed, during which a laceration of the liver was detected. His medical history is otherwise unremarkable.

He does not smoke and there is no family history of malignancies or cardiac or respiratory diseases.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 8,500/mm3
Neutrophils: 70%
Lymphocytes: 28%

Hb: 13.1 g/dL
Hct: 40%

Platelets : 331,000/mm3
X-Ray Chest

Performed

The x-ray shows unilateral elevation of the right hemidiaphragm. The right lung shadow appears normal otherwise. The left lung shadow, hemidiaphragm and cardiac silhouette appear normal, while the trachea is central.
CT chest and Abdomen

Performed

The CT scan reveals a defect in the right diaphragm with intrathoracic herniation of the liver. Basal atelectasis of the right lung is noted.
ECG

Performed

The ECG appears normal.

Select Relevant Management
Nil Orally stat
Bronchodilators
Thoracic Surgery
Conservative management