Posterolateral Bochdalek diaphragmatic hernia in adults

Abstract

Bochdalek hernias (BHs) are produced in the posterolateral area of the diaphragm. They are generally congenital, appearing in childhood, but are also detected in asymptomatic adult patients seeking medical attention for other reasons. Computed tomography (CT) or magnetic resonance imaging (MRI) is used for the correct diagnosis of the hernia type and for its localization, facilitating its management and the choice of treatment. We describe three cases of Bochdalek hernia, two on the right side and one bilateral, which was larger on the right than left side. All of these hernias contained only omental fat. In one patient, the right kidney was adjacent to the diaphragmatic defect but remained within the abdomen. The patients showed no symptoms and were not surgically treated. Examination by multislice CT with the possibility of coronal and sagittal reconstruction should be considered the standard method for diagnosing this entity. MRI in T1 is highly valuable to evaluate fat-containing chest lesions. The incidental finding of BH in asymptomatic adults is increasing, thanks to the wider application of new imaging techniques.

Symptomatic Bochdalek Hernia in Adult: a Case Report

“…Symptoms, if any, are typically imprecise. Patients usually report chest pain or gastrointestinal symptoms [10], as the patient in this case, who reported complaints of postprandial epigastralgia refractory to pharmacological treatment, and dyspnea. It could often lead to a wrong diagnosis.…”

“…It could often lead to a wrong diagnosis. Surgical treatment is necessary due to the complication range related to this hernia type, which, although often asymptomatic, may lead to tissue strangulation [10], pneumothorax and intestinal necrosis [11].…”

Congenital Diaphragmatic Hernias: Occurence in Adults

“…Yetişkin çağda asemptomatik kişilerde Bochdalek herni saptama sık-lığı gittikçe artmaktadır. Bu durum obesitenin artması ve aynı zamanda görüntüleme tekniklerinde artışa da bağlanmaktadır (22).…”

Imaging the posterior mediastinum: a multimodality approach

“…However, asymptomatic Bochdalek hernias can be incidentally found in 10.5% of adults undergoing chest or abdominal CT examinations (67). CXR may fail to show the herniation, whereas CT and MRI allow accurate detection and characterization of Bochdalek hernia and such potential complications as bowel incarceration, strangulation, or perforation (68,69).…”

“…15) and the contents of the hernia sac (67,71). This defect is the key finding for differentiating a Bochdalek hernia from diaphragmatic eventration or a diaphragmatic lipoma or liposarcoma (68).…”