PMC5585677_01
Portable supine chest radiograph shows suspected elevation of the left hemidiaphragm (yellow arrows) with underlying haziness and air-filled viscus over the lower left hemithorax. In retrospect, the suspected "elevated" diaphragmatic contour actually represents the wall of the stomach that herniated through a diaphragmatic hiatus.
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fig1
Her work-up included a chest X-ray and CT scan of the chest, abdomen, and pelvis that revealed left lung contusion with herniation of the stomach into the left hemithorax (Figures 1-3).
Postcontrast (intravenous) coronal (a) and sagittal (b) CT images illustrate a classic "collar" sign with focal waist-like narrowing of the gastric body (yellow arrows) as it extends from the abdominal cavity into the thorax at the site of diaphragmatic hernia.
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fig2
Her work-up included a chest X-ray and CT scan of the chest, abdomen, and pelvis that revealed left lung contusion with herniation of the stomach into the left hemithorax (Figures 1-3).
Postcontrast (intravenous) axial CT image confirms a fluid-filled viscus (yellow asterisk) in the lower left thoracic cavity.
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fig3
Her work-up included a chest X-ray and CT scan of the chest, abdomen, and pelvis that revealed left lung contusion with herniation of the stomach into the left hemithorax (Figures 1-3).
Laparoscopic view showing herniation of the stomach (yellow arrow, filled) and the transverse colon (yellow arrow, not filled) into the thorax.
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fig4
Herniated bowel through a 9 cm posterior left diaphragmatic defect contained most of the stomach, loops of small bowel, and the transverse colon (Figures 4 and 5).
Laparoscopic view showing the diaphragmatic defect (outlined by dashed yellow oval).
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fig5
Herniated bowel through a 9 cm posterior left diaphragmatic defect contained most of the stomach, loops of small bowel, and the transverse colon (Figures 4 and 5).
Laparoscopic view showing repair of the diaphragmatic defect.
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fig6
We determined that a tension-free repair could be performed primarily without the use of mesh, with running silk suture followed by interrupted reinforcement sutures (Figure 6).