CTICasesDelayed Traumatic Diaphragmatic Hernia with Hepatothorax
Imaging findings
An 18-year-old woman with a chest radiograph showing a retrocardiac mass has CT confirming this represents liver herniated into the thorax through a diaphragmatic defect, in continuity with the intra-abdominal liver on coronal imaging. Review of remote trauma imaging from five years earlier (a motor vehicle collision) retrospectively shows liver already present in the chest with a lower mediastinal hematoma, extrapleural blood tracking along the diaphragm, gas in the mediastinum, and a small splenic laceration that was the only injury documented at the time.
Key takeaways
A diaphragmatic hernia containing liver, with an asymmetrically thinned crus and evidence of an old, unrecognized mediastinal hematoma on prior trauma imaging, indicates a traumatic diaphragmatic/central tendon rupture that went undiagnosed at the time of the original injury and became more apparent as the patient grew; diaphragmatic and splenic injuries are known to occur together, and this combination should raise suspicion for a missed diaphragmatic tear even when only a splenic injury was originally documented.
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