Pericardio-diaphragmatic rupture: five new cases and literature review.

This report adds five new cases to the world literature on pericardio-diaphragmatic rupture (PDR). Five of 48 (10.4%) consecutive cases of traumatic diaphragmatic rupture (TDR) seen by a single surgeon over a 22-year period were PDR. These rare cases include a case associated with air bag deployment, a case of double rupture involving both the pericardium and left diaphragm, and a case resulting from penetrating trauma. This series suggests that PDR may be under-reported as a percentage of TDR. Only 65 cases of PDR have been reported previously. Review of the world literature on PDR is included. Anatomic factors, mechanisms of injury, differential diagnosis, diagnostic techniques, and treatment considerations for PDR are discussed.