A case of traumatic diaphragmatic hernia presenting a distinct thoracic abnormal shadow after a long course of disease

Abstract

A 43-year-old man came to our hospital for further examination of a thoracic abnormality pointed out on a check-up examination. Chest X-ray revealed a protruding tumor shadow on the right diaphragm. The patient had a history of right precordial contusion due to a traffic accident about 2 years previously, and after the injury a shadow appeared which gradually became larger, suggesting traumatic right diaphragmatic rupture-induced hernia. Chest CT scan revealed middle hepatic vein within the tumor without changes such as deviation and/or stenosis and hepatoparenchymatous tumor. Ultrasonography revealed the tumor to comprise a part of the liver (S4, S8) with the normal internal echo and the right diaphragm dividing the liver parenchyma in two, intrathoracically and intraperitoneally. The above led to the diagnosis of right diaphragmatic hernia, which probably was caused by the traffic injury and gradually increased during approximately 2 years. In cases of suspected traumatic right hemidiaphragmatic hernia, ultrasonography is regarded as useful.