PMC10432773_01
Chest radiograph in posteroanterior and lateral views: shows a poorly defined left diaphragmatic copula with retrocardiac shadow. Opacification of the left lower lung zone shows an internal air column continuing with abdominal gases, suggestive of a left diaphragmatic hernia.
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Chest radiography posteroanterior: opacity of the left lower lung zone showing the internal column of air continuous with abdominal gases, with well-defined left cardiac border with loss of lower transparency (posterior inferior location), features suggestive of left diaphragmatic hernia (Fig. 1a and b). Postoperatively he had bilateral lower lobes atelectasis and was treated conservatively (Fig. 1c). The follow-up chest X-ray was normal (Fig. 1d).
Chest radiograph anteroposterior: post operative with repair of the diaphragmatic hernia, left pleural drainage tube is noted.
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There is a small left pleural effusion with subsegmental compression atelectasis of the left lower lobe due to the effusion and hernia (Fig. 2a and 2b).
Chest radiograph lateral view: Intact left diaphragmatic copula was demonstrated, and a bilateral basal linear atelectatic plate is noted.
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Dissection was performed until a very large firm mass of amalgamated Omentum (15 x 12 x 12 cm) overlying and covering the herniated stomach arose from the left copula of the diaphragm (Fig. 3a). The mass was resected and separated from the stomach (Fig. 3b). The herniated stomach was seen through a defect in the left copula of the diaphragm and placed in an anatomic position without rotation or compression (Fig. 3a). Finally, the left diaphragmatic defect was closed with Proline size 1 and re-enforcement with Proline Mesh (Fig. 3d).