PMC7378314_01
Preoperative chest radiograph.. A) and B) There was no abnormal shadow at the age of 49 (A), but two years later, there was an abnormal shadow (white arrows) in the left lung field (B).
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A chest radiograph revealed an abnormal shadow in the left lower lung field (Fig. 1B) that had not been detected two years previously (Fig. 1A).
Preoperative CT images showing hernia components (red arrows) and the hernial orifice (yellow arrows).. A) and B) Sagittal CT images: mediastinal (A) and pulmonary (B) window settings, respectively. C) Coronal CT image: pulmonary window setting. D), E) and F) Axial CT images: mediastinal (D and F) and pulmonary window (E) settings.
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Chest contrasted CT examination revealed herniation of 10 x 5 cm of retroperitoneal fatty tissue into the left thoracic cavity (Fig. 2).
Thoracoscopic views of left chest cavity.. A) Abdominal tissue (white arrows) covered with parietal pleura (white asterisk) has herniated into the extra-pleural cavity through a left posterolateral diaphragmatic defect (white arrow heads). The hernia components are surrounded by the left diaphragm (yellow asterisk), left lower lobe (green asterisk), and vertebral body (red asterisk). B) The thoracoscopic findings after dissection of the pleural membrane (yellow arrows) showing a 5 cm that the hernia orifice (white arrows) and fatty tissue (white arrow heads). C) The hernial orifice (white arrows) was about 2 cm in size after resection of the retroperitoneal fatty tissue. D) Thoracoscopic findings after repair of BH by direct suturing.
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Intraoperatively, we found that retroperitoneal fatty tissue had herniated into the extra-pleural space via a 2-cm diameter hernia orifice (Fig. 3).