Traumatic diaphragmatic hernia - delayed presentation

Case contributed by Dr Bruno Di Muzio

Presentation

Subacute right chest pain and relative shortness of breath.

Patient Data

Age: 70 years
Gender: Female
X-ray

Chest radiographs

There is homogeneous opacity within the region of the right middle lobe with indistinct diaphragmatic and right heart contours on the PA projection. No pleural effusion seen within the posterior costophrenic recesses. The remainder of the lungs is clear. 

There is a defect of the right hemidiaphragm with partial liver herniation into the thorax. Features of centrilobular emphysema and a right upper lobe anterior segment spiculated nodule, which is highly concerning for a primary lung malignancy. Also, left upper lobe rounded pulmonary nodule. 

Arrows showing the right hemidiaphragm with the liver herniating through. 

Case Discussion

This patient was involved in a major MVA 6 months prior to this presentation. The features are those of a likely missed traumatic laceration of the diaphragm presenting now as a large liver herniation. 

The defect was surgically corrected with a mesh. The RUL lesion was confirmed as a low-grade lung adenocarcinoma. LUL rounded pulmonary nodule was PET negative. 

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Case information

rID: 64490
Published: 2nd Dec 2018
Last edited: 2nd Dec 2018
System: Chest, Trauma
Inclusion in quiz mode: Excluded

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