Large posterior diaphragmatic hernia

Case contributed by Dr Amr Farouk


Right breast mass. CT to assess for metastases.

Patient Data

Age: 76 years old

CT scanogram demonstrates gas filled structure overlying the mediastinum. 

 A large posterior mainly central diaphragmatic defect is seen with bulging abdominal viscera namely the stomach, small bowel loops, transverse colon and omentum into the posterior mediastinum reaching superiorly to T3/4 level, pushing the heart & the carina anteriorly and causing pulmonary parenchymal compression collapse of basal segments of both lower lobes.

Clear rest of the aerated lung parenchyma. Right breast ill defined mass is seen measuring 2 X 1.4 cm. No C.T evidence of enlarged hilar or mediastinal lymph nodes. No pleural or pericardial sac collections. Aortic and coronary calcifications are noted. Trachea and proximal bronchial mural calcifications are noted.

The examined skeleton showed:

  • exaggerated dorsal kyphotic curvature (Gibbus deformity)
  • dorsal spondylotic changes
  • T10 and T11 vertebral wedging & structural collapse

Case Discussion

Large posterior diaphragmatic defect with posterior mediastinal herniation of abdominal viscera and subsequent mass effect in the form of pulmonary parenchymal collapse & cardiac anterior shift.

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