Compression fracture of the T12 vertebra combined with diaphragmatic hernia after low-energy trauma: a case report and literature review.

BACKGROUND

Vertebral compression fractures are common in middle-aged and elderly patients with osteopenia; however, their coexistence with diaphragmatic hernia (DH) is rare and easily overlooked, especially when diaphragmatic hernia presents without typical respiratory or gastrointestinal symptoms.

CASE PRESENTATION: We report a case of a 56-year-old woman with osteopenia who developed a T12 vertebral compression fracture combined with acute exacerbation of a pre-existing diaphragmatic defect following a ground-level fall. The patient presented with persistent thoracolumbar pain and right lower limb pain for five days, with no classic symptoms of diaphragmatic hernia on admission. The key diagnostic clue was identified on initial chest radiography, which demonstrated reduced left lung volume and elevation of the left hemidiaphragm; subsequent chest computed tomography (CT) confirmed the diagnosis, revealing a left diaphragmatic defect with herniation of the greater omentum and colon into the thoracic cavity. The patient first underwent video-assisted thoracoscopic surgery (VATS) for diaphragmatic hernia repair, followed by percutaneous kyphoplasty (PKP) for the vertebral fracture after her condition stabilized. She recovered well and was discharged after systematic treatment.

CONCLUSION

This case indicates that for patients with thoracolumbar vertebral fractures caused by blunt trauma, chest CT should be performed promptly when abnormal findings are detected on chest radiography or when patients present with nonspecific abdominal or thoracic symptoms, to exclude concomitant diaphragmatic hernia, achieve early diagnosis, and reduce the risk of diagnostic delay.