PMC3038627_01
Bedside chest radiograph showed a right upper lucency (curved arrow) with left mediastinal shift in relationship with tension pneumothorax. The air present in the lower part of the right hemithorax was retrospectively interpreted as caecal distension with perforation.
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fig1
The admission chest X-ray showed a large lucent right hemithorax with left mediastinal shift (Figure 1).
Multidetector CT performed after contrast medium injection and reformation in the frontal plane (a) revealed a large defect in the right diaphragm with herniation of the right colon (straight arrow). Fluid present above the right diaphragm is explained by the distension and perforation of the caecum (double arrows). Note the dilatation of the small bowel loops in relationship with incarceration of the caecum through the diaphragm defect. Maximal intensity projection (MIP) performed on a posterior plane (b) revealed the migration of the right colonic artery (straight arrow) with the ascension of the right colon. Inset: intraoperative view of the right colon herniated through the Bochdalek hernia (arrow).
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fig2
Since the patient did not have a typical history for a lung infection and her initial symptoms were abdominal pain, a contrast-enhanced thoracoabdominal computed tomography (CT) was performed (Figure 2). Exploratory laparotomy was performed and showed an incarcerated right diaphragmatic hernia containing the terminal ileum and the caecum up to the middle part of the right colon (Figure 2).