PMC4898079_01
69-year-old man with chronic diaphragmatic hernia. PA chest radiograph demonstrates a focal air collection (arrow) at the left lung base with adjacent pulmonary atelectasis (arrowheads).
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Chest radiography (Fig. 1) demonstrated an air collection at the left lung base, which was surrounded by a rim of atelectatic lung parenchyma.
69-year-old man with chronic diaphragmatic hernia. Axial enhanced CT image through the lower chest shows a portion of the stomach (arrow) lying within the left thoracic cavity.
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An enhanced chest CT (Figure 2A, Figure 2B) revealed the air collection to represent a portion of stomach that had herniated through a defect in the left hemidiaphragm.
69-year-old man with chronic diaphragmatic hernia. Axial enhanced CT image approximately 3 cm distal to the prior image shows a portion of the stomach (white arrow) streaming through the diaphragmatic defect (arrowheads). Postoperative changes of Nissen fundoplication (black arrow) are partially visualized.
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A portion of the greater curvature of the stomach, as well as a substantial portion of associated fat, had herniated through a small defect in the left diaphragm and into the thoracic cavity (Fig. 3A). The scar around the defect was excised and the hernia contents reduced (Fig. 3B). A 6 x 6 cm piece of polytetrafluoroethylene (PTFE) Gore DualMesh was fashioned and secured circumferentially with interrupted sutures to the musculature of the diaphragm (Fig. 3C).
69-year-old man with chronic diaphragmatic hernia. Intraoperative photograph of the stomach herniating through the left diaphragmatic defect.
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A chest radiograph obtained postoperatively (Fig. 4) demonstrated a normal subdiaphragmatic position of the gastric air bubble.