Presentation
Presented after being hit by a car approximately two weeks prior. For past two days has had increased respiratory rate.
Patient Data
There is marked pleural effusion with retraction of the lung lobes. The cardiac silhouette is outlined by the pericardial fat and is elevated from the sternum. The stomach is cranially deviated and rugal folds travel in the direction of the thorax.
Case Discussion
Diaphragmatic hernia. The liver is likely displaced into the thorax because of its position cranial to the stomach and the elevation of the heart from the sternum. The stomach may be at the diaphragm or in the thoracic cavity.
The horizontal beam radiograph takes advantage of physics to displace the fluid ventrally and the gas dorsally. This allows us to see the stomach position more clearly, although the liver is still not visible.
A laparotomy was performed and found two diaphragmatic tears in the central and right regions. Two liver lobes were retrieved from the thoracic cavity and the diaphragm was repaired.
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