Esophageal Injury Masquerading as Diaphragmatic Injury

Diaphragmatic injury secondary to blunt trauma is a relatively rare entity. Early diagnosis and appropriate management define patient outcomes. This set of images describes a gentleman in his late teens who was referred from another center after left-sided intercostal drainage for a blunt thoracoabdominal injury following a motor vehicle collision. A CT scan revealed suspicion of a diaphragmatic injury with gastric herniation and possible perforation; however, intra-operative findings revealed a distal esophageal perforation with a normal diaphragmatic contour. The radiological picture could be explained based on intra-operative findings, resulting in an interesting injury pattern.