Q: Recently, a 54 years old obese man was hospitalised for severe respiratory problems. The problem get aggravated by touching the chest and during sleeping. He had asthma and bronchitis. He was taking Clopidogrel, Statin, steroid inhalers and Telma-blood pressure medicine. He was taken to intensive care unit with very low blood pressure. He was put on ventilator. The chest x-ray revealed fractures in the rib cage. The diaphragm had ruptured. Emergency surgery was done and it was found that the organs in the abdomen had gone into the thorax region and were putting pressure on the lungs. The patient neither had a fall nor was hit externally. Why did the rib bones fracture? Is it possible that during violent coughing the rib cage could have fractured and diaphragm ruptured?

A:It is very unlikely that the diaphragm ruptured spontaneously during cough. Rib fractures are known with cough in patients with osteopenia. Most likely the patient had a thinned out diaphragm e.g. with eventration and was unaware of this. The thinned out part may have ruptured spontaneously. Weight reduction is of paramount importance in such patients to be able to lead a good quality life. It is also necessary to rule out obstructive sleep apnoea in someone like this.