PMC4418537_01
Figure 1A - Chest radiograph at time of presentation demonstrated a right sided diaphragmatic hernia with bowel in right chest and contralateral mediastinal shift. Black asterisk denotes liver in thorax.. Figure 1B - Coronal magnetic resonance image of patient's chest. In right chest, liver is seen herniating and area of fusion to underdeveloped right lung is denoted by white arrow.
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F1
A chest radiograph revealed a right-sided diaphragmatic hernia with bowel in the thorax and mediastinal shift to the contralateral side. (Figure 1a) Thoracoscopy was performed, however, after placement of a 5mm port in the right 4th intercostal space in the mid-axillary line, no intrapleural anatomy was identified.
PMC4418537_02
Figure 2A - View from abdomen. Black arrow denotes site of hepatic pulmonary fusion. White arrows show border of diaphragmatic defect. White asterisk on lung and black asterisk on liver. Retractor is seen at right side of image.. Figure 2B - After approximation of diaphragmatic defect. Black asterisk is liver, black arrow is PTFE mesh and white arrow is polyester fiber mesh connecting liver to the PTFE patch.
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F2
A polytetraflouroethylene (PTFE) patch was used to repair the defect laterally except in the area that the liver was fused to the lung. A strip of polyester fiber mesh was then sewn from the PTFE patch to the capsule of the liver. (Figure 2b) The post-operative course was uneventful.