Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax

Abstract

Traumatic diaphragmatic hernia (TDH) is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.

Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication

“…In cases of right sided CDH, an intrathoracic liver may be damaged by a chest drain. Similar cases have been reported with chest tube insertion leading to iatrogenic perforation in patients with undiagnosed diaphragmatic hernia [6] , [7] . X-ray abdomen showing gastric and intestinal gas shadow in continuity with that in the ipsilateral hemithorax gives a clue to the possibility of CDH.…”

“…It can mimic and be misdiagnosed as congenital lung cyst and bullae, pyothorax, pneumothorax, gastric volvulus [5] . While treating a misdiagnosed case, there are high chances of injuring the herniating content [6] , [7] . A high index of clinical suspicion is the key to prevent the catastrophic iatrogenic complications.…”

Dual Chest Pathology Presenting with Acute Respiratory Failure: A Case Report and Review of Literature

“…Pradeep et al described a case of lately presented CDH with iatrogenic gastric perforation by chest tube insertion on assumption of left sided pyothorax [13]. Similar cases have been reported with chest tube insertion leading to iatrogenic perforation in patients with undiagnosed diaphragmatic hernia [14,15].…”

Spinal cord compression by a pulmonary hernia

“…Compression of the spinal cord by the lung is very rare. In the brief review of the literature, the authors did not retrieve any pulmonary traumatic hernia through the intercostal space, 6 diaphragm, 7 and cervical area, 8 and a search in PubMed also failed to retrieve any case of spinal cord compression due to a traumatic pulmonary hernia. The authors found only one case 9 of a traumatic jejunal hernia between the L1 and L2 bodies in a 3-week-old infant, but without spinal compression; the trauma mechanism was a spinal hyperextension.…”