Delayed herniation of abdominal contents through a ruptured left hemidiaphragm
Diagnosis certain
Presentation
Motor vehicle collision.
Patient Data
Age: 30 years
Gender: Female
Presenting chest x-ray
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Hypoinflated lungs, widened upper mediastinum.
Chest CT at presentation
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Moderate left pneumothorax, bilateral dependent atelectasis. Patchy increased opacity right lung, likely pulmonary contusion. Torn lateral aspect left hemidiaphragm with herniation of a small amount of abdominal fat into the left hemithorax.
Chest X-ray 1 hour later
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New left pigtail catheter left pleural space, no pneumothorax. Hypoinflated lungs.
Chest x-ray 2 days later
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Herniation of colon into the left chest.
Chest CT 2 days later
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Interval herniation of colon, part of the spleen, mesenteric vessels, and mesenteric fat into the left chest through a large lateral defect in the left diaphragm.
Case Discussion
This case illustrates that herniation of abdominal contents into the chest through a torn diaphragm may be delayed.
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