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Gillaspie EA. Imaging of the Diaphragm: A Primer. Thorac Surg Clin 2024; 34:119-125. [PMID: 38705659 DOI: 10.1016/j.thorsurg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The diaphragm is a critical musculotendinous structure that contributes to respiratory function. Disorders of the diaphragm are rare and diagnostically challenging. Herein, the author reviews the radiologic options for the assessment of the diaphragm.
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Affiliation(s)
- Erin A Gillaspie
- Division of Thoracic Surgery, Creighton University Medical Center, 7500 Mercy Boulevard, Omaha, NE 68124, USA.
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2
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Predescu D, Achim F, Socea B, Ceaușu MC, Constantin A. Rare Diaphragmatic Hernias in Adults-Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature. Diagnostics (Basel) 2023; 14:85. [PMID: 38201394 PMCID: PMC10795705 DOI: 10.3390/diagnostics14010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias-Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1-7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm2 (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%.
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Affiliation(s)
- Dragos Predescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Florin Achim
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Surgery, “Sf. Pantelimon” Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Mihail Constantin Ceaușu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Histopathology, Alexandru Trestioreanu” National Institute of Oncology, 022328 Bucharest, Romania
| | - Adrian Constantin
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
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Hasnaoui A, Trigui R, Heni S, Ramdass PVAK. Iatrogenic incarcerated diaphragmatic hernia following laparoscopic resection of a diaphragmatic cystic lymphangioma: A case report. Int J Surg Case Rep 2023; 112:108947. [PMID: 37826978 PMCID: PMC10582341 DOI: 10.1016/j.ijscr.2023.108947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Incarcerated iatrogenic right diaphragm hernia stands as a rare occurrence. Swift diagnosis and timely management are imperative. This article presents a particularly uncommon case of a right diaphragmatic hernia resulting from a neglected defect following the resection of a diaphragmatic lymphangioma and sheds light on the pitfalls that may lead to such a post-operative event. PRESENTATION OF CASE Our surgical ward admitted a 36-year-old patient presenting symptoms indicative of bowel obstruction. Four months earlier, the patient had undergone laparoscopic resection of a lymphangioma located in the right dome of the diaphragm. Thoracic auscultation yielded hyperactive bowel sounds at the lower lung field and the right costophrenic angle. Abdominal distention was observed without any signs of peritoneal irritation. A thoracic and abdominal CT scan provided confirmation of a right diaphragmatic hernia. Subsequently, an immediate laparotomy was performed. The right colic hepatic flexure was released, and the diaphragmatic breach was sutured. The postoperative course was uneventful. DISCUSSION Iatrogenic diaphragmatic hernia remains a possible complication of this surgery. It could occur even on the right side where the liver has a cushioning effect. Incarcerated diaphragmatic hernia is a surgical emergency that should be operated on as quickly as possible. A systematic check of the diaphragm's integrity at the end of the surgical procedure could prevent such complications. CONCLUSION While surgical techniques and laparoscopic instrumentation have witnessed significant advancements in recent years, achieving proficiency and the precise execution of surgical techniques remain of utmost importance.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Sihem Heni
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Prakash V A K Ramdass
- St. George's University School of Medicine, Department of Public Health and Preventive Medicine, St. George, Grenada
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Gayer G, Shroff GS, Truong MT. Two unusual fat-containing mediastinal entities: Pearls and pitfalls in imaging of Morgagni hernia and fat necrosis. Semin Ultrasound CT MR 2022; 43:267-278. [PMID: 35688537 DOI: 10.1053/j.sult.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review focuses on 2 fat-containing entities in the mediastinum that may raise a diagnostic challenge: Morgagni's hernia and Epipericardial (mediastinal) fat necrosis. Familiarity with the typical imaging findings of these 2 entities is vital for the radiologist to recognize and accurately characterize unusual mediastinal pathological conditions.
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Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Stanford Medical Center, Stanford, CA.
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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5
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Gielis M, Bruera N, Pinsak A, Olmedo I, Fabián PW, Viscido G. Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report. Int J Surg Case Rep 2022; 93:106910. [PMID: 35339034 PMCID: PMC8956794 DOI: 10.1016/j.ijscr.2022.106910] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction and importance Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%. Case presentation We report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence. Clinical discussion Diaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair. Conclusion Laparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach. Traumatic diaphragmatic injuries are rare and usually occur after polytraumatism. Emergency surgery is the treatment of choice of even tiny diaphragmatic ruptures. Laparoscopic approach is safe and effective in hemodynamically stable patients. Primary repair consists in watertight closure with nonabsorbable interrupted suture. In large defects placement of a mesh is recommended to reinforce the primary repair.
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Affiliation(s)
- Manuel Gielis
- Department of General Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina.
| | - Nicolás Bruera
- Department of General Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina
| | - Agustín Pinsak
- Department of General Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina
| | - Ignacio Olmedo
- Department of Thoracic Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina
| | - Paez Walter Fabián
- Department of Thoracic Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina
| | - German Viscido
- Department of General Surgery, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Córdoba PA 5000, Argentina
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Çankal F, Demir B, Köksal A. Evaluation of diaphragmatic omental hernias by radiology: A prevalence study. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2022. [DOI: 10.4103/ijawhs.ijawhs_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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7
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Metchihoungbe CS, Sogbo DHO, Koco H, Yassegoungbe MG, Covi AP, Amoussou AM, Segbedji GGPS, Safari DK, Gogan MVLSB, Assouto CBU, Biaou O, Fiogbe MA. Congenital retro-costo-xiphoid diaphragmatic hernia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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8
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Alomari L, Khushaim A. Diagnosis of Epipericardial Fat Necrosis on multimodality imaging in a pediatric patient: a case report and review of the literature. J Radiol Case Rep 2020; 14:16-24. [PMID: 33082923 DOI: 10.3941/jrcr.v14i5.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This is a case report of a 13-year-old male, presented to the Emergency Department complaining of a sudden onset left-sided pleuritic chest pain for 1 day. He was found to have a mass in the left Epipericardial fat with fat stranding and pleural effusion supporting the diagnosis of Epipericardial Fat Necrosis. The findings were established by Computed tomography and Ultrasound, and the final diagnosis was confirmed by Magnetic resonance imaging. Subsequently, the patient was discharged on analgesia; reassessment one-month later showed clinical improvement with no symptom recurrence. Repeated Ultrasound demonstrated a marked decrease in size and echogenicity of the mass. In this paper we review the clinical and radiological manifestations of Epipericardial fat necrosis and the different management approaches taken over the years.
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Affiliation(s)
- Lama Alomari
- Department of Emergency Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ayman Khushaim
- Department of Radiology, McGill University Health Center, Montreal, Canada
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Liu CH, Horng HC, Wang PH. A case of ovarian cancer present with acute respiratory distress: Spontaneous rupture of diaphragm. Taiwan J Obstet Gynecol 2020; 58:712-714. [PMID: 31542099 DOI: 10.1016/j.tjog.2019.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Huann-Cheng Horng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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10
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Bilateral Bochdalek Hernias Associated with Arnold-Chiari I Malformation. Case Rep Radiol 2020; 2020:1931879. [PMID: 32047696 PMCID: PMC7007740 DOI: 10.1155/2020/1931879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
A Bochdalek hernia is a posterolateral diaphragmatic defect that is either congenital or acquired. The contents of the hernia range from fat to intra-abdominal organs. They are primarily pathologies of neonates and most commonly occur unilaterally. These hernias have been described in isolation and as one part of a group of malformations. There have been reports of Bochdalek hernias in association with myelomeningocele and other neural tube defects. We present a unique case of bilateral Bochdalek hernias in a 35-year-old female with an Arnold-Chiari I malformation.
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11
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Kao AM, Ross SW, Otero J, Maloney SR, Prasad T, Augenstein VA, Heniford BT, Colavita PD. Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair. Surg Endosc 2019; 34:1785-1794. [DOI: 10.1007/s00464-019-06930-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
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12
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Muthu V, Sagar S, Sehgal IS, Thurai Prasad K, Dhooria S, Singla V, Agarwal R. A 19-Year-Old Young Man With Breathlessness and Opacity in the Left Hemithorax. Chest 2019; 156:e1-e4. [PMID: 31279379 DOI: 10.1016/j.chest.2018.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/14/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sathya Sagar
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veenu Singla
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Pontecorvi V, Dioscoridi L, Giannetti A, Mutignani M. Symptomatic huge diaphragmatic hernia. BMJ Case Rep 2019; 12:12/3/e229286. [PMID: 30898946 DOI: 10.1136/bcr-2019-229286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Valerio Pontecorvi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Lorenzo Dioscoridi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Aurora Giannetti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimiliano Mutignani
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Chaturvedi A, Rajiah P, Croake A, Saboo S, Chaturvedi A. Imaging of thoracic hernias: types and complications. Insights Imaging 2018; 9:989-1005. [PMID: 30484078 PMCID: PMC6269341 DOI: 10.1007/s13244-018-0670-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/06/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. Multiple imaging modalities are available to evaluate thoracic hernias. Radiographs usually offer the first clue to the diagnosis. Upper gastrointestinal radiography can identify bowel herniation and associated complications. CT and occasionally MR can be useful for further evaluation of these abnormalities, accurately identifying the type of hernia, its contents, associated complications, and provide a roadmap for surgical planning. In this article, we review the different types of thoracic hernias and the role of imaging in the evaluation of these hernias. TEACHING POINTS: • Protrusion of lung contents beyond the anatomic confines of the thorax constitutes a hernia. • Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. • Multiple imaging modalities are available to evaluate thoracic hernias. • CT is the imaging modality of choice for identifying thoracic hernias and their complications. • Imaging can provide a roadmap for surgical planning.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Prabhakar Rajiah
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexender Croake
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | - Sachin Saboo
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Apeksha Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
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Darocki MD, Medak AJ. Spontaneous Diaphragmatic Hernia. Clin Pract Cases Emerg Med 2018; 2:244-246. [PMID: 30083643 PMCID: PMC6075501 DOI: 10.5811/cpcem.2018.5.38587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
A spontaneous diaphragmatic hernia (SDH) occurs when intra-abdominal contents extend into the thoracic cavity through a defect in the diaphragm after a sudden increase in intra-abdominal pressure. SDH is one of the rarest surgical emergencies with less than 30 reported cases in the literature.1,2 In our case a 94-year-old female presented to the emergency department in respiratory distress with unilateral breath sounds and was diagnosed with a SDH. The only treatment option for a SDH is surgical.3,11 However, nasogastric tube decompression of the gastrointestinal tract and supplemental oxygen can be used to alleviate symptoms until definitive operative management is performed.
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Affiliation(s)
- Mark D Darocki
- University of California San Diego, Department of Emergency Medicine, San Diego, California
| | - Anthony J Medak
- University of California San Diego, Department of Emergency Medicine, San Diego, California
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Yu HX, Han CS, Xue JR, Han ZF, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert Rev Gastroenterol Hepatol 2018; 12:319-329. [PMID: 29451037 DOI: 10.1080/17474124.2018.1441711] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manifestations include gastric reflux, nausea, bloating, chest and epigastric discomfort, pharyngeal and esophageal expulsion and dysphagia. Weight loss and colorectal bleeding are severe symptoms. Areas covered: This review summarizes updated evidence of pathophysiology, risk factors, diagnosis and management of hiatal hernias. Laparoscopy and oesophagectomy procedures have been discussed as surgical procedures. Expert commentary: Endoscopy identifies untreatable gastric reflux; radiology is better for pre-operative assessments; manometry measures esophageal peristalsis, and CT scanning detects gastric volvulus and associated organ ruptures. Gastric reflux disease is mitigated using antacids and proton pump and histamine-2-receptor blockers. Severe abdominal penetration into chest cavity demands surgical approaches. Hence, esophagectomy has chances of post-operative morbidity, while minimally invasive laparoscopy entails fewer postoperative difficulties and better visualization of hernia and related vascular damages.
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Affiliation(s)
- Hai-Xiang Yu
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Chun-Shan Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Jin-Ru Xue
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Zhi-Feng Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Hua Xin
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
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Chetambath R, Parengal J, Aslam M, Shivashankaran S. A rare clinical case presenting as right lower zone shadow. Lung India 2018; 35:173-175. [PMID: 29487258 PMCID: PMC5846272 DOI: 10.4103/lungindia.lungindia_99_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Morgan TA, Shum DJ, Basta AM, Filly RA. Prognosis in Congenital Diaphragmatic Hernia Diagnosed During Fetal Life. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Occhipinti M, Heidinger BH, Franquet E, Eisenberg RL, Bankier AA. Imaging the posterior mediastinum: a multimodality approach. Diagn Interv Radiol 2016; 21:293-306. [PMID: 25993732 DOI: 10.5152/dir.2014.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information.
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Affiliation(s)
- Mariaelena Occhipinti
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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Takahashi R, Akamoto S, Nagao M, Matsuura N, Fujiwara M, Okano K, Suzuki Y. Follow-up of asymptomatic adult diaphragmatic hernia: should patients with this condition undergo immediate operation? A report of two cases. Surg Case Rep 2016; 2:95. [PMID: 27612870 PMCID: PMC5017960 DOI: 10.1186/s40792-016-0220-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asymptomatic diaphragmatic hernia is generally thought to be rare among adults. We present two different types of asymptomatic diaphragmatic hernia diagnosed with computed tomography (CT) and discuss treatment strategies. CASE PRESENTATION Case 1: A 37-year-old woman was diagnosed with catamenial pneumothorax in the right diaphragm. Partial resection of the diaphragm and lung was performed using a linear stapler. She was asymptomatic after the operation and gave birth 2 years later. After delivery, she experienced recurrent pneumothorax, and CT revealed a right diaphragmatic defect with herniation of a part of the liver into the thorax. An iatrogenic diaphragmatic hernia was diagnosed. There has been no change in the size of the hernia and no symptoms due to the diaphragmatic hernia for more than 3 years after it was diagnosed. Case 2: A 75-year-old woman was previously diagnosed with rectal cancer and had undergone surgery after chemoradiotherapy. One year after surgery, herniation of a 3 × 1.3-cm section of retroperitoneal fat tissue into the left thoracic cavity was observed incidentally at a follow-up CT and was diagnosed as an adult Bochdalek hernia (BH). We reviewed the patient's past CT findings and confirmed that the same finding had been present since the first scan. A wait-and-see approach was chosen because there had been no change in the size of hernia, there were no symptoms, the patient was elderly, and there was a high risk of recurrence of the rectal cancer. She has had no symptoms to date, and careful follow-up has been performed. CONCLUSIONS There are few reports of asymptomatic adult diaphragmatic hernia. Although symptomatic diaphragmatic hernia is generally treated surgically, there are cases in which a wait-and-see approach has been applied, such as our asymptomatic cases.
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Affiliation(s)
- Ryota Takahashi
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Shintaro Akamoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Mina Nagao
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Natsumi Matsuura
- Department of General Thoracic, Breast, and Endocrinological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita, Kagawa, 761-0793, Japan
| | - Masao Fujiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Bilateral Morgagni Hernia: A Unique Presentation of a Rare Pathology. Case Rep Radiol 2016; 2016:7505329. [PMID: 27403367 PMCID: PMC4923526 DOI: 10.1155/2016/7505329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/29/2016] [Indexed: 11/20/2022] Open
Abstract
Morgagni hernia is an unusual congenital herniation of abdominal content through the triangular parasternal gaps of the anterior diaphragm. They are commonly asymptomatic and right-sided. We present a case of a bilateral Morgagni hernia resulting in delayed growth in a 10-month-old boy. The presentation was unique due to its bilateral nature and its symptomatic compression of the mediastinum. Diagnosis was made by 3D reconstructed CT angiogram. The patient underwent medical optimization until he was safely able to tolerate laparoscopic surgical repair of his hernia. Upon laparoscopy, the CT findings were confirmed and the hernia was repaired.
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Yang T, Yang J, Li J, Pan J, Zou Y. An unusual cause of shortness of breath in a young boy. Thorax 2016; 71:772-3. [PMID: 27053575 DOI: 10.1136/thoraxjnl-2016-208497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/15/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Tianyou Yang
- Department of Pediatric surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Jiliang Yang
- Department of Pediatric surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Jiahao Li
- Department of Pediatric surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Jing Pan
- Department of Pediatric surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Yan Zou
- Department of Pediatric surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
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Abbey-Mensah GN, Waite S, Reede D, Hassani C, Legasto A. Diaphragm Appearance: A Clue to the Diagnosis of Pulmonary and Extrapulmonary Pathology. Curr Probl Diagn Radiol 2015; 46:47-62. [PMID: 26383624 DOI: 10.1067/j.cpradiol.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022]
Abstract
The diaphragm is often overlooked or incompletely evaluated when interpreting chest radiographs. Alterations in the appearance of the diaphragm on chest radiographs such as elevation, contour abnormalities, adjacent lucency, and calcifications can offer clues to pulmonary and extrapulmonary pathology. Familiarity with common causes of these alterations facilitates the appropriate selection of additional imaging and leads to the diagnosis of both benign and life-threatening processes. This article reviews normal variations in the appearance of the diaphragm as well as those associated with pulmonary and extrapulmonary pathology.
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Affiliation(s)
| | - Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Deborah Reede
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Cameron Hassani
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Alan Legasto
- Department of Radiology, Weill Cornell Medical Center, New York, NY
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25
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Charalampoudis P, Kostakis ID, Doula C, Mantas D. A tricky late occurrence of Bochdalek's hernia. BMJ Case Rep 2015; 2015:bcr-2014-207765. [PMID: 25804945 DOI: 10.1136/bcr-2014-207765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Panda A, Bhalla AS, Sharma R, Arora A, Gupta AK. “Straddling Across Boundaries”—Thoracoabdominal Lesions: Spectrum and Pattern Approach. Curr Probl Diagn Radiol 2015; 44:122-43. [DOI: 10.1067/j.cpradiol.2014.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 12/28/2022]
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Ozkan A, Bozkurter Cil AT, Kaya M, Etcioglu I, Okur M. Late presenting Bochdalek hernia with gastric perforation. Pediatr Emerg Care 2015; 31:47-9. [PMID: 25560621 DOI: 10.1097/pec.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Late-onset congenital diaphragmatic hernias that give symptoms beyond the neonatal period are rare and are difficult to diagnose. The diagnosis is usually made in case of complications such as intestinal obstruction, strangulation, and perforation, which further necessitate immediate surgical repair. The case of a 5-year-old child presenting with acute respiratory distress with gastric strangulation and perforation secondary to Bochdalek hernia is reported here. Although presentation in the latter ages is less common, congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in children. Symptoms and diagnostic tools should truly be interpreted. Gastrointestinal complications must urgently be recognized, and early surgical intervention must be performed.
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Affiliation(s)
- Aybars Ozkan
- From the *Department of Pediatric Surgery, Duzce University; †Department of Pediatric Surgery, Duzce Atatürk Government Hospital; ‡Department of Radiology, Duzce Atatürk Government Hospital; §Department of Pediatrics, Duzce University, Duzce, Turkey
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28
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A rare case of Morgagni hernia associated with cor triatriatum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2014.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Hatzidakis A, Kozana A, Glaritis D, Mamoulakis C. Right-sided Bochdalek hernia causing septic ureteric obstruction. Percutaneous treatment with placement of a nephroureteral double pigtail. BMJ Case Rep 2014; 2014:bcr-2014-207247. [PMID: 25362189 DOI: 10.1136/bcr-2014-207247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of an 86-year-old female patient who presented with a septic, right ureteric obstruction, caused by a symptomatic Bochdalek hernia. The patient was initially managed with percutaneous nephrostomy and final treatment was achieved by placement of an external-internal nephroureteral double pigtail.
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Affiliation(s)
- Adam Hatzidakis
- Department of Radiology, University of Hospital Heraklion, Heraklion, Greece
| | - Androniki Kozana
- Department of Radiology, University of Hospital Heraklion, Heraklion, Greece
| | | | - Charalampos Mamoulakis
- Department of Urology, University of Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
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30
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Maroules CD, Ghoshhajra BB, Malguria N, Landay M, Hummel J, Ferencik M, Abbara S. Noncardiac Incidental Findings on Cardiac CT: A Step-by-Step Approach. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Golden J, Barlow M, Mitchell I, Lipskar A, Prince JM. Repair of a bilateral Morgagni hernia in a premature, extremely low birth weight infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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32
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Hirano ES, Silva VG, Bortoto JB, Barros RHDO, Caserta NMG, Fraga GP. Plain chest radiographs for the diagnosis of post-traumatic diaphragmatic hernia. Rev Col Bras Cir 2013; 39:280-5. [PMID: 22936226 DOI: 10.1590/s0100-69912012000400007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 01/21/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe changes in the radiographic examination of the chest in patients with post-traumatic diaphragmatic hernia (PTDH) confirmed intra-operatively. METHODS Between January 1990 and August 2008 45 patients with PTDH were treated. We analyzed demographic data, cause of injury, changes in chest radiography (CXR), extent and location of the diaphragmatic lesion and herniated organs. We described the radiographic findings most frequently identified by surgeons and radiologists. RESULTS CXR was performed on 32 patients, predominantly male (27 cases, 84.4%) and the mean age was 34 years. The most common cause of injury was blunt trauma (25 cases, 78.1%). Radiographic examination of the chest showed changes suggestive of PTDH in 26 cases (81.3%). During exploratory laparotomy, left PTDH was found in 28 cases (87.5%) and right in four (12.5%). The most frequently herniated organ was the stomach. CONCLUSION The study showed that CXR is very useful in the initial diagnostic approach to PTDH. The difficulty is that diaphragmatic injuries, particularly after penetrating trauma, may initially go unnoticed, and without changes in the CXR images, diagnosis is made difficult.
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