Incidental diaphragmatic hernias found in adults – A pictorial essay

Congress:

ECR 2020

Poster Number:

C-03059

Type:

Educational Exhibit

Keywords:

Not applicable, Volvulus, Hernia, Congenital, Complications, CT, Conventional radiography, Trauma, Thorax, Stomach (incl. Oesophagus), Chest

Authors:

A. B. Giurgiu¹, F. R. Eniu², B. AANEI¹, D. Munteanu³; ¹Cluj-Napoca/RO, ²Cluj/RO, ³Cluj-Napoca, Cluj/RO

DOI:

10.26044/ecr2020/C-03059

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-03059

Fig. 1: Chest X-rays (antero-posterior and lateral view): depict a retrocardiac soft...

Fig. 2: Contrast-enhanced CT of thorax, abdomen and pelvis (68 y.o. female patient, no...

Fig. 3: Contrast-enhanced abdominal CT (67 y.o. male patient, no symptoms related to...

Fig. 4: Contrast-enhanced CT of thorax, abdomen and pelvis (72 y.o. male patient, no...

Learning objectives

1. Become familiar with types of asymptomatic diaphragmatic hernias (DH) in adult population 2. Understand imaging features and possible mimickers of DH 3. Discuss potential complications which may occur in evolution of occult DH

Background

Diaphragmatic hernia is defined as a defect in the diaphragm, which allows herniation of the abdominal content into the thorax. Detection of asymptomatic DH is rare among adults, being generally associated with increased intra-abdominal pressure, due to blunt trauma, physical exertion or pregnancy, with hiatal hernia being the commonest type. Rarely, it may occur due to a previously unidentified congenital diaphragmatic defect (Bochdalek and Morgagnihernia) [1]. Chest X-rayis the first line imaging technique used for indentifying any thoracic pathology, being frequently responsible for detecting incidental...

Findings and procedure details

Hiatal hernia Hiatal hernia (HH) is characterized by protrusion of stomach or abdominal viscera, into the thoracic cavity through the esophageal hiatus [1]. It ismainly caused byweakening of the phrenoesophageal ligament and widening of the esophageal hiatus in case of increased intraabdominal pressure [2]. Often asymptomatic, HH are an incidental finding on chest radiograph, which reveals a retrocardiac mass containing air-fluid level (Fig.1) [2]. Current classification of HH comprises of four subtypes, based on the position of the gastroesophageal junction in relationship to the esophageal...

Conclusion

Widespread use of MDCT for the evaluation of thoracic and abdominal pathology in adult population results in increasing detection of incidental DH, with precise characterization of herniated viscera, diaphragmatic defects and possible associated complications.

Personal information and conflict of interest

A. B. Giurgiu; Cluj/RO - nothing to disclose B. Aanei; Cluj/RO - nothing to disclose F. R. Eniu; Cluj/RO - nothing to disclose D. Munteanu; Cluj, CLUJ/RO - nothing to disclose

References

1. Chaturvedi A, Rajiah P, Croake A, Saboo S, Chaturvedi A. Imaging of thoracic hernias: types and complications. Insights into Imaging 2018; 9:989–1005. 2. Siegal SR, Dolan JP, Hunter JG. Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg 2017; 402:1145–1151. 3. Verde F, Hawasli H, Johnson PT, Fishman EK. Gastric volvulus: unraveling the diagnosis with MPRs. Emergency Radiology 2019, doi: 10.1007/s10140-019-01669-0. 4. Fisichella PM, Jalilvand A, Dobrowolsky A. Achalasia and Epiphrenic Diverticulum. World J Surg 2015; doi: 10.1007/s00268-015-2950-7. 5. Satija L, Joshi P,...