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Case Reports
. 2016 Apr;10(4):PD04-5.
doi: 10.7860/JCDR/2016/17506.7544. Epub 2016 Apr 1.

Delayed Diagnosis of Left-Sided Diaphragmatic Hernia in an Elderly Adult with no History of Trauma

Goutham Reddy Katukuri  1 , Jagadesh Madireddi  1 , Sumit Agarwal  2 , Hashir Kareem  3 , Tom Devasia  4
Affiliations
Case Reports

Delayed Diagnosis of Left-Sided Diaphragmatic Hernia in an Elderly Adult with no History of Trauma

Goutham Reddy Katukuri et al. J Clin Diagn Res. 2016 Apr.

Abstract

Diaphragmatic Hernia (DH) is the herniation of abdominal contents into the thorax through a rent in the diaphragm. Acquired DH most commonly occurs following a blunt or penetrating trauma to the abdomen with former being common than the later. Very rarely DH can be spontaneous and be asymptomatic until it's very extensive. A 78-year-old presented with breathlessness and chest pain of one month duration. There was dull note to percussion and absent breath sounds in left lower zone. Auscultation revealed bowel sounds in left infra-axillary and mammary area. Electrocardiogram and laboratory data suggested acute myocardial infarction. Coronary angiogram showed a triple vessel disease. Roentgenogram was simulating pneumonic consolidation but presence of air shadows was the thing against pneumonic consolidation. CT imaging of the thorax revealed an extensive left diaphragmatic hernia with viscera and left kidney as its contents. He was initially taken up for CABG and surgery for diaphragmatic hernia was planned at a later date. This case is important for its extensive nature and for its rarity as acquired DH rarely occurs spontaneously. Chest roentgenogram must be read cautiously in all such cases to look for this entity. Auscultation for bowel sounds in the thorax is a diagnostic clue.

Keywords: Acquired diaphragmatic hernia; Pleural effusion; Pneumonic consolidation.

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Figures

[Table/Fig-1a]:
[Table/Fig-1a]:
PA view simulating pneumonic consolidation but presence of air fluid levels point towards diaphragmatic hernia.
[Table/Fig-1b]:
[Table/Fig-1b]:
CT thorax lung window coronal view: Red arrow above shows omentum and White arrow below shows large bowel.
[Table/Fig-2]:
[Table/Fig-2]:
CT thorax lung window coronal view: Red arrow (above) shows small bowel with mesentry and white arrow (below) shows kidney.
See this image and copyright information in PMC

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