Presentation
Referred for CTPA study.
Patient Data
Posteroanterior (PA) chest radiograph demonstrates double density of the right hemidiaphragm (black and white arrow). Lateral chest radiograph shows abrupt termination of the anterior portion of the right hemidiaphragm (white arrow) before reaching the retrosternal/pericardiac fat (red arrow). Double density of the right hemidiaphragm is again appreciated. The posterior portion of the right hemidiaphragm is labeled by the black arrow. The left hemidiaphragm is labeled by blue arrow.
Coronal and sagittal view shows defect in the anterior diaphragm posterior to the xiphoid process with herniation of mesenteric fat into anterior mediastinum. The right hemidiaphragm has an undulating appearance likely weakened by the defect. This allows mild protrusion of the left lobe of the liver, covered by the diaphragm, into the right hemithorax. This gives the double density appearance seen on the PA and lateral chest radiographs.
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