Post-traumatic diaphragmatic hernias – importance of basic radiographic investigations

Abstract

This case presentation highlights important principles in the management of post-traumatic diaphragmatic hernia. A suggestive history should prompt early diagnosis even if the patient appears well. The chest radiograph, although not pathognomonic, is extremely useful in the detection of diaphragmatic hernia if accurately interpreted. Herniated bowel is at high risk of strangulation, especially in the presence of a 'ribbon sign'. Delayed operative intervention can prove fatal.

Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack

“…Chest X-ray is the initial investigation of choice in patients with suspected diaphragmatic hernia and has sensitivity of 30–62% [ 10 ]. Radiographic features suggestive of diaphragmatic hernia include an elevated hemidiaphragm, distortion or obscuring of the diaphragmatic margin, bowel shadows or air/fluid levels above the diaphragm, intrathoracic presence of the nasogastric tube, associated pleural collection, lung collapse, and contralateral mediastinal shift.…”