Case of the week 11.7.22
Publication Date: 2022-11-07
3 images
Findings
Thorax ventrodorsal and lateral radiographs were acquired after hours.
The left diaphragmatic margin is ill-defined and the stomach and several segments of small intestine are present within the left pleural space. Best identified on the ventrodorsal radiograph, there is a long, triangular, soft tissue opaque structure within the left pleural space which conforms to the margin of the body wall and extends from the left first rib to the left ninth rib. On the right lateral radiograph, there is a triangular soft tissue opaque structure which spans from the fourth ribs to the seventh ribs and is superimposed with the cardiac silhouette. Immediately caudal to this triangular soft tissue opaque structure, at the level of the eighth intercostal space, there are multiple, variably sized, round to angular mineral opaque foci; the largest of which measures approximately 0.8 cm in diameter (non-calibrated).
There is a mild volume of gas and fluid within the pleural space of both hemithoraces which results in mild dorsal displacement of the cardiac silhouette from the sternum and obscuration of the ventral margins of the cardiac silhouette.
There is a mild, unstructured interstitial to alveolar pulmonary pattern within the right caudal lung lobe. There is a mild, diffuse unstructured interstitial pulmonary pattern throughout the remainder of the pulmonary parenchyma.
The visible margins of the cardiac silhouette and pulmonary vessels are normal.
There is a complete, transverse fracture of the right sixth rib which is displaced cranially, proximally and laterally and results in a concave defect in the body wall at this level. The fracture margins are angular.
There is a mild to moderate volume of soft tissue swelling and subcutaneous emphysema along the right lateral body wall.
There is mild, focal, incidental spondylosis deformans at the T12-13 intervertebral disc space.
Diagnosis
- Left-sided diaphragmatic hernia with resultant herniation of the stomach, portions of the small intestine, spleen, liver and suspected gallbladder (with concurrent cholelithiasis) and concurrent bilateral pneumothorax and pleural effusion (likely representing hemorrhage) consistent with reported vehicular trauma.
- The unstructured interstitial and alveolar pulmonary patterns likely represent a combination of both contusion and atelectasis.
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