BACKGROUND
Traumatic diaphragmatic injuries are uncommon in thoracoabdominal trauma, and traumatic diaphragmatic crural hematoma (TDCH) is even rarer in this context. Because of its retroperitoneal position, TDCH can be difficult to detect early. Although TDCH is usually not life-threatening and does not often require emergency surgery, it is important to note that it often coexists with other serious injuries. This report describes the case of TDCH and shock following crush trauma. After stabilization, whole-body contrast-enhanced CT identified TDCH and unstable pelvic fractures. She then underwent diagnostic angiography followed by surgical management of the pelvic injuries.
CASE REPORT
A 63-year-old woman with no prior health issues was brought to the emergency department after being accidentally crushed between 2 vehicles while her husband was reversing his car. She experienced pain in her chest, abdomen, and right hip. Initially in shock, she stabilized following initial resuscitation and blood transfusion. Initial evaluation, including extended FAST ultrasound (E-FAST), was negative. Contrast-enhanced CT scan showed fractures of the right sacrum, iliac wing, acetabulum, and pubic rami, along with a hematoma in the bilateral diaphragmatic crura (T12-L1) with contrast extravasation. Diagnostic angiography showed no active contrast extravasation from the diaphragm or pelvis. She subsequently underwent surgical fixation of pelvic fractures. Her postoperative course was uneventful, and she was discharged in stable condition.
CONCLUSIONS
This case highlights that TDCH is rare and may indicate a high-energy injury requiring prompt diagnosis. Whole-body contrast-enhanced CT is reasonable in patients presenting with shock and negative E-FAST findings. Management should be guided by bleeding status, and diagnostic angiography may be considered when active bleeding is suspected.

Keywords: Diaphragm; Thoracic Injuries; Retroperitoneal Space