J Korean Neurosurg Soc.  2015 Feb;57(2):131-134. 10.3340/jkns.2015.57.2.131.

Delayed Traumatic Diaphragm Hernia after Thoracolumbar Fracture in a Patient with Ankylosing Spondylitis

• Lee HH
• Jeon I
• Kim SW
• Jung YJ

• KMID: 2191196
• DOI: http://doi.org/10.3340/jkns.2015.57.2.131

Abstract

Traumatic diaphragm hernia can occur in rare cases and generally accompanies thoracic or abdominal injuries. When suffering from ankylosing spondylitis, a small force can develop into vertebral fracture and an adjacent structural injury, and lead to diaphragm hernia without accompanying concomitant thoracoabdominal injury. A high level of suspicion may be a most reliable diagnostic tool in the detection of a diaphragm injury, and we need to keep in mind a possibility in a patient with ankylosing spondylitis and a thoracolumbar fracture, even in the case of minor trauma.

Keyword

Diaphragm hernia; Ankylosing spondylitis; Delayed; Thoracolumbar fracture

MeSH Terms

Abdominal Injuries
Diaphragm*
Hernia*
Humans
Spondylitis, Ankylosing*

Figure

• 

  Fig. 1 Chance fracture on the L2, presenting on preoperative CT scan. There are fractures of the lamina, spinous process, and vertebral body with a canal compromise on CT scan. The findings of ankylosing spondylitis including syndesmophyte, bamboo spine are shown in CT scan.

• 

  Fig. 2 There are air shadows (large black arrow) in the right hemithorax and trachea deviation to the left side on the chest X-ray at the time of arrest (about 6 weeks later from the accident) (A). Pneumothorax (black arrow) and a 9th rib fracture (white arrow) of the right hemithorax in the initial chest X-ray at the time of admission (B) and postoperative aggravation (C). Two weeks later, the improved status of atelectasis and consolidation is showing on the follow-up chest X-ray (D).

• 

  Fig. 3 A: A chest CT scan shows the viscerothorax containing large bowel and fluid collection in the right hemithorax after the sudden arrest. The heart and lungs are deviated to the opposite side by the herniated abdominal contents. B: There are disruption of the right crus (white arrow) from vertebra body compare to the left crus and extensive destruction of right hemidiaphragm and peri-vertebral structures.

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