I have a hematoma in the left diaphragm due to perforation. How do I overcome the pain caused by it?

Q. How can someone overcome the pain caused by a diaphragmatic perforation?

Answered by
Dr. Muhammad Shoyab
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 15, 2022

Hi doctor,

I fell off the surgery table eight years ago during gynecologic laparoscopy. I was sent home with multiple symptoms without further diagnosis. I had a stroke two years ago, and I also suffer from lung infections. There is a pain when I breathe. However, I underwent blood tests and other diagnostic tests, but nothing was found. Last month I underwent an ultrasound of the upper left abdomen, which revealed a hematoma-like structure below the left diaphragm. Afterward, a CT scan was done and reviewed by my doctor. He found a perforated left diaphragm. In addition, my recent laboratory reports revealed thrombocytes up to 5.50 lakhs, leukocytes up to 16,000 mcL, and a low CRP level. Also, my lipase levels were three times more elevated than the normal range, and LDH was elevated twice its normal range. I am currently taking tablet Oxycodon 50 mg per day. Also, I have pain in the thoracic region, gastric issues, and an accumulation of liquid surrounding the liver (which comes and goes). However, I felt better after the infusion of IV antibiotics and fasting. So, what could be the diagnosis, and what can be done?

Please help.



Welcome to icliniq.com.

I understand your concern.

I have seen the CT (computed tomography) and USG (ultrasonography) screenshots, but it is not appropriate to make an opinion based on screenshots (attachment removed to protect the patient's identity). Could you please upload the full set of DICOM images? So that I could make a complete and more confident evaluation. However, from the screenshots, it seems that the diaphragm perforation you mentioned is quite small. Of course, such a small defect can also contribute to recurrent chest infections, pain, etc. Other than that, I can also see that the left kidney is swollen. So, please upload the full images for proper evaluation.

Kindly follow up with the images.

Take care.

Hi doctor,

Thank you for your reply.

Did I understand correctly that a perforation of the left diaphragm seems possible? This is the most important question. The swollen kidney has already been diagnosed, and there was even an abscess in the uterus. Both have been surgically removed, but my symptoms have exacerbated ever since. So I asked if there was something overseen in the suspected area of the diaphragm. Kindly tell me about the diaphragm rupture.

Please help.



Welcome back to icliniq.com.

Yes, a diaphragm defect seems possible. To confirm, the radiologist needs to look at the full images. Also, please note that the diaphragm perforations are often tricky and may take some time to be detected.

Kindly follow up with the DICOM images.

Take care.

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