Incidental Diaphragmatic Hernia

diaphragmatic hernia

This elderly lady presented with delirium, but no other medical history could be obtained. The chest x-ray showed what was assumed (by the medical registrar) to be a right sided pleural effusion. He was keen to drain it. Luckily, the physician decided that he wanted a CT of the chest first, which revealed a large right-sided diaphragmatic hernia.

The scout image from the CT is shown, which demonstrates colonic bowel gas and soft-tissue density corresponding to the liver herniating into the right hemithorax. There is also Paget’s disease of the right humerus.

Incidentally-discovered posterior diaphragmatic hernias (Bochdalek hernias) are rare (0.17% of patients having an abdominal CT). Of these, right-sided hernias are more common (68%). The great majority are small, with only 27% containing abdominal organs such as bowel, spleen or liver.

Reference: Mullins ME, et al. Prevalence of Incidental Bochdalek’s Hernia in a Large Adult Population. AJR 2001; 177:363-366

Credit: Dr Michael Tam