Presentation
Work-up for shortness of breath. History of a car accident about one year ago.
Patient Data
Large defect in the right hemidiaphragm, with herniation of some omental fat, the distal ascending and proximal transverse colon, part of the posterior aspect of the right liver lobe, and the gallbladder through it into the right hemithorax, giving the cottage loaf sign, better appreciated on sagittal images.
Adjacent reduced lung aeration and mild right-to-left shift of the heart and mediastinum.
Old fractures with union seen at the posterolateral aspect of the right lower ribs and the right scapular body.
Case Discussion
Traumatic right sided diaphragmatic rupture with partial herniation of the liver through the diaphragmatic defect, called the cottage loaf sign.
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