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A 34 year old man was evaluated in the emergency department for a two day history of abdominal pain, nausea, vomiting, dyspnoea, and breathlessness. He had a history of blunt abdominal trauma 13 years ago with recurrent symptoms of bowel obstruction resolving spontaneously. The patient reported having had bowel movements the morning of his presentation but no subsequent passing of flatus. His temperature was 37.3°C with slight sinus tachycardia (108/mn) and blood pressure of 100/60 mm Hg. He was lethargic but normally oriented. Physical examination revealed mild tenderness in the mid abdomen with absent bowel sounds. No breath sounds were heard in the left lower thorax. Laboratory work demonstrated elevated white blood cell count. Plain chest films obviated an elevated diaphragm bilaterally, more pronounced on the left side. A thoracoabdominal computed tomography scan study was undertaken (fig 1).
How can the left hemithorax content be related to the patient’s complaints?
See page 1498for answer
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