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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 116 Date 2000-01-15

  • Courtesy of Koun-Sik Song, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 37 / F
  • Chief ComplaintVomiting and epigastric pain after meal. Traffic accident and operation due to bowel perforation (9 years ago)
  • Figure 1
  • Figure 2
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Diagnosis With Brief Discussion

Diagnosis
Traumatic Diaphragmatic Hernia with Delayed Presentation
Radiologic Findings
Chest radiographs show collapsed lung with air-fluid level in left hemithorax.
There is no gastric gas seen at expected location.
CT scans show fluid-filled stomach and collapsed bowel loops with omentum within left hemithorax.
Dilatation of the proximal jejunum as well as stomach is noticed .
One month ago, we missed the diaphragmatic hernia of the splenic flexure of colon on colon study (below).

Brief Review
Surgical Findings
Large defect was detected at left hemidiaphragm and herniation of entire stomach and a part of transverse colon with omentum.
There was chronic inflammation around herniated colon and omentum, except stomach.
Adhesive band was noted at ileum.


Discussion
Diaphragmatic rupture occurs in about 5% of patients who have experienced major blunt trauma.
95% of diaphragmatic ruptures are on the left side.
Diaphragmatic rupture is frequently not recognized at the time of trauma and the interval between injury and the onset of symptoms ranged from several weeks to years.
The most common herniated viscera were the stomach and colon.
CT scan identify discontinuity of diaphragm (absent diaphragm sign), especially posterolateral aspect. Herniated organs manifest a "waist" or collar sign.
References
1. Lin YK, Huang BS, Shih CS, Hsu WH, Huaug MH, Lee CH. Traumatic diaphragmatic hernia with delayed presentation. Chung Hua I Hsueh Tsa Chih 1999;62:223-229
2. Worthy SA, Kang EY, Hartman TE, Kwong JS, Mayo JR, Muller NL. Diaphragmatic rupture: CT findings in 11 patients. Radiology 1995;194:885-888
Keywords
Diaphragm, Trauma,

No. of Applicants : 28

▶ Correct Answer : 23/28,  82.1%
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  • - 源€吏€
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  • - 議곗˜誘
  • - 源€
  • - NANVATI HOSPITAL BOMBAY BHARAT GALA
  • - Samsung Medical Center Kyung Soo Lee
  • - Sarnia general hospital, Ontario, Canada Nazih Shenouda
  • - Seoul National University Hospital Jung-Gi Im
  • - Stedelijk OLV-Ziekenhuis Mechelen, Belgium Pilate Ivan
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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