CT
Axial lung window
Sagittal non-contrast
Axial non-contrast
Non-contrast CT nicely demonstrates a huge gap in the left hemidiaphragm medially and dorsally with consecutive herniation of a large portion of the stomach into the thoracic cavity. The stomach abutts and mildly compresses the left heart with moderate midline shift of the mediastinum. Compression and discrete atelectasis of the left lower lung zone. NGT in place.
Splenic malrotation with the hilum pointing upwards towards the hernia, most likely in keeping with the prolapsed stomach and consecutive upwards pull of neighbouring abdominal structures.
The rest of the visualised thorax and abdomen is unremarkable, particularly no evidence of diaphragmatic rupture, no free fluid, no haematoma, no pneumothorax, no pneumoperitoneum.
CONCLUSION:
Congenital Bochdalek hernia with herniation of large parts of the stomach into the chest cavity.
No traumatic diaphragmatic rupture.