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About 10% of all trauma patients sustain rib fractures. The average age is 58. Men are more often affected than women. Hemothorax, pneumothorax, and lesions of the lung are not uncommon. Very rare are injuries of the pericardium, aorta, and subclavia caused by fractured ribs. We present a very unusual case where a broken rib caused a severe diaphragmatic hemorrhage with a hemothorax and acute hypovolemia. The primary chest X-ray was thought to be without pathology. Arterial bleeding without exact localization could be found with computed tomography. Thoracotomy revealed the correct diagnosis and the cause of bleeding.

If the known collateral pathways for a stenosed or occluded coeliac trunk are not avialable whether for anatomical of haemodynamic reasons, a collateral circulation can be established through the suprarenal and inferior phrenic arteries to provide a significant flow. This is particularly so if the inferior phrenic artery arises from the coeliac trunk distal to the point of occlusion. The development of a reno-coeliac steal phenomenon or steal syndrome may then be expected, particularly if the main donor artery is a suprarenal branch arising from the renal artery.

A corrosion - cast anatomical study was performed on human livers. At first arterio-arterial anastomoses between the inferior phrenic arteries and branches of the main hepatic artery were investigated. Secondly, arterial communications between the right and left hepatic artery are described. 1. The anatomical-functional study of phrenico-hepatic anastomoses gives new detailed information on the arterial blood supply of the liver out of the phrenic arteries. These collaterals are a consistent finding. By far the largest part of the phrenicohepatic anastomoses is derived from the right inferior phrenic artery. The superior and posterior segments receive most of the anastomoses. In about 10% of our cases we succeeded in filling almost the whole arterial system of the liver by injecting the inferior phrenic arteries. 2. There are three anastomotic pathways from the right hepatic artery to the left: the so-called portal anastomoses (hilar anastomoses), translobar vessels, and the capsular arteries.