Presentation
Chronic dyspnea. No past history of trauma.
Patient Data
There are multiple air-filled loops within the left hemithorax with indistinct ipsilateral hemidiaphragm and paucity of bowel gas in the upper abdomen. Mediastinal shift to the right. The right lung is clear.
There is a large central diaphragmatic defect with intrathoracic herniation of stomach, splenic flexure, small bowel, vast amounts of the mesentery, and corporeocaudal segment of the pancreas. The stomach shows an "upside-down" configuration with the antrum and pylorus superior to the fundus and proximal body which may indicate a mesentero-axial volvulus. The heart and mediastinal structures are displaced to the right.
Case Discussion
A diaphragmatic hernia in a patient with no past history of trauma or injury is most likely of congenital origin.