Presentation
History of being kicked by a horse several months ago. Presents for respiratory distress.
Patient Data
There is increased opacity in the thoracic cavity on all projections. The lung lobe margins are rounded and retracted with visible fissure lines, indicating pleural effusion. The opacities in the thoracic cavity include soft tissue and gas opacity with a granular appearance. This is mostly present on the right side, and the diaphragm is not visible on the right. The cardiac silhouette is displaced to the left by this mass effect. The left hemithorax is more normal in appearance. The normal hepatic silhouette is not visible in the abdominal cavity, and the stomach is positioned more cranially. There is poor detail in the abdomen suggesting peritoneal effusion.
Case Discussion
Chronic diaphragmatic hernia on the right side with secondary bicavitary effusion. The liver and a portion of the intestine were located in the pleural space.
At surgery, there were two rents in the right diaphragm with herniation of small intestine and liver.
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