CTICasesIncarcerated Traumatic Diaphragmatic Hernia from a Remote Stab Wound
Imaging findings
A 48-year-old man presenting with acute left-sided chest and abdominal pain was found to have an abnormality in the left lower hemithorax that appeared to represent a pleural effusion, but CT showed omental and mesenteric fat with numerous vessels herniating through a small focal defect in the left hemidiaphragm at its midportion.
Key takeaways
Although initially characterized as a Bochdalek-like hernia, the location was atypical for a congenital Bochdalek or Morgagni hernia. Further history revealed a stab wound to the left chest approximately 20 years earlier, and the omentum was found to be incarcerated and edematous at surgery, confirming a remote, previously unrecognized traumatic diaphragmatic injury that presented decades later with incarceration. The case underscores the importance of obtaining a history of prior trauma, surgery, or penetrating injury whenever an unusual diaphragmatic defect is identified.
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