Workup for cough and breath shortness.
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There is herniation of some peritoneal fat through a 40 mm diaphragmatic defect in the posterolateral aspect of right hemidiaphragm.
Features on CT scan can be compatible with Bochdalek hernia which is a form of congenital diaphragmatic hernia. They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero. Retroperitoneal structures may prolapse through the defect.
Large hernias typically present in infancy, are usually are said to be most frequently left-sided. In adults, incidentally-discovered posterior diaphragmatic hernias are rare (0.17% of patients having an abdominal CT). Of these, right-sided hernias are more common (68%), and more frequent in females.
- Temizöz O, Gençhellaç H, Yekeler E et-al. Prevalence and MDCT characteristics of asymptomatic Bochdalek hernia in adult population. Diagn Interv Radiol. 2010;16 (1): 52-5. doi:10.4261/1305-3825.DIR.2750-09.1 - Pubmed citation
- Mullins ME, Stein J, Saini SS et-al. Prevalence of incidental Bochdalek's hernia in a large adult population. AJR Am J Roentgenol. 2001;177 (2): 363-6. AJR Am J Roentgenol (full text) - Pubmed citation