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Special Feature
August 2002

Image of the Month

Author Affiliations

From the Department of Surgery, University of Texas Medical Branch, Galveston.




Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

Arch Surg. 2002;137(8):971. doi:

A 54-YEAR-OLD restrained driver was involved in a rollover motor vehicle crash and came to the emergency department complaining of shortness of breath, left pleuritic chest pain, and back pain. Her vital signs included the following: heart rate, 73 beats/min; blood pressure, 172/102 mm Hg; and respirations, 18/min. Although the patient's breath sounds were decreased on the left side, her oxygen saturation was 95% using a 100% oxygen non–rebreather face mask. The patient's chest x-ray film is shown in Figure 1.

What Is the Diagnosis?


B.Hiatal hernia

C.Diaphragmatic rupture

D.Pulmonary contusion.