CTICasesAcquired Intrathoracic Gastric and Colonic Herniation (Acquired Diaphragmatic Hernia)
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Imaging findings
A rapidly developed diaphragmatic hernia in an older man with advanced Alzheimer's disease who presented nonverbal and not breathing well. The radiograph clearly showed gas-containing structures (colon with stool) displacing the heart and mediastinum. CT confirmed intrathoracic herniation of stomach and colon, which compressed the right lower lobe and displaced the heart to the left. An old chest CT from 2013 showed no diaphragm defect. The patient had a lot of stool in his colon and his esophagus was full of gas.
Key takeaways
Acquired diaphragmatic hernias can develop rapidly, even without a clear history of trauma, potentially due to factors such as chronic motility issues, chronic bowel distension, and excessive air swallowing, especially in patients with cognitive impairment like Alzheimer's disease. These can lead to significant herniation of abdominal contents (stomach, colon) into the chest, causing mediastinal displacement and lung compression, requiring urgent recognition and management.
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