Sonographic findings of a Bochdalek hernia: The importance of ring‐down artifacts

Yang, Dal Mo; Kim, Hyun Cheol; Jin, Wook

doi:10.1002/jcu.20854

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…The sonographic appearance of CDH in adults has been rarely described because it is uncommon. 11,12 In one of the described cases, the herniating content was only intra-abdominal fat, producing a nonspecific finding of ring-down artifacts, 12 whereas in the other case, a disfigured spleen provided a clue to the existence of a diaphragmatic defect. 11 In the index case, we were able to see bowel loops in the left hemithorax and clearly demonstrate the diaphragmatic defect and the altered anatomy of the spleen and kidney using POCUS.…”

Section: Discussionmentioning

confidence: 91%

A 19-Year-Old Young Man With Breathlessness and Opacity in the Left Hemithorax

Muthu

Sagar

Sehgal

et al. 2019

Chest

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A 19-year-old young man presented with exertional breathlessness of 4 years' duration which was nonprogressive. There were no complaints of chest pain, cough, palpitation, hemoptysis, fever, anorexia, or weight loss. He denied history of any addictions. There was no history of trauma to the chest. He had been empirically treated for TB in the past, based on chest radiography finding of left-sided pleural effusion. However, a diagnostic thoracentesis was never attempted. On examination, heart rate and respiratory rate were 82 beats/min and 18 breaths/ min, respectively. The movements of chest were reduced and an impaired note on percussion was noted over the infra-axillary, infrascapular, and mammary areas on the left side. On auscultation, the intensity of breath sounds was reduced over the aforementioned areas. The rest of the physical examination was unremarkable. Chest radiograph revealed obliteration of the left costophrenic angle with a homogenous radiodensity suggestive of a pleural effusion (Fig 1). We performed a point-of-care ultrasonography (POCUS) (Videos 1-3). Question: What does the ultrasound show and what is the most likely diagnosis?Figure 1 -Chest radiograph showing obliteration of the left costophrenic angle with a homogenous radiodensity.

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Section: Discussionmentioning

confidence: 91%

A 19-Year-Old Young Man With Breathlessness and Opacity in the Left Hemithorax

Muthu

Sagar

Sehgal

et al. 2019

Chest

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“…Two abdominal ultrasounds (AUS) showed disfigured spleen with fragmented echogenic line of hemi-diaphragm, 3 and a sonographic "ring-down" artefact behind herniated fat. 4 Only one report of TUS using a linear transducer described bowel loops with visible peristalsis in the posterior left hemithorax with normal lung sliding immediately cranially, but without visualizing the hemi-diaphragm. 5 In contrast, our POC-TUS could visualize normal gut above an ill-defined F I G U R E 1 CXR erect film showed left hemithorax opacity with "meniscus sign" (arrow) (A) and left decubitus film showed "shifting opacity" (double arrow) (B), suggestive of a free-flowing left pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

Bochdalek hernia masquerading as pleural effusion in a young adult

Wong

Lam

Yam

2023

Respirology Case Reports

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Bochdalek hernia (BH) is a congenital diaphragmatic hernia which rarely presents in adulthood. We report on a 25‐year‐old man admitted with 3‐year recurrent and self‐limiting abdominal pain and vomiting. Chest radiograph showed left pleural opacity which shifted position in the decubitus film suggesting pleural effusion. Before attempting drainage, point‐of‐care (POC) thoracic ultrasound (TUS) demonstrated features of intrathoracic gastrointestinal content above the left hemi‐diaphragm. Computed tomography of the thorax confirmed a large left BH. Acute recurrent symptoms 3 months post‐discharge was associated with BH enlargement and early bowel ischemia, which was successfully managed by emergency surgery. This case illustrates the importance of pre‐procedural imaging with POC‐TUS before pleural procedures in all cases of suspected or apparent pleural effusion, and of prompt surgical treatment of symptomatic BH despite clinical stabilization.

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