Massive ipsilateral pleural effusion caused by transdiaphragmatic intercostal hernia
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Fig. 1
Chest radiographies obtained 2 months earlier (A) and on admission (B). Note the newly developed, massive pleural effusion in the left hemithorax.
Fig. 2
A coronary reconstructed view of MDCT of the lower chest and abdomen. Note the mesentery (asterisk) passing through the defect of the diaphragm (arrow) and a TDIH within the left eighth intercostal space (arrowhead).
Abstract
Transdiaphragmatic intercostal hernia (TDIH) is a rare consequence from blunt chest-abdominal injury. The diagnosis of TDIH is often delayed. We report a patient who had a history of left-sided upper abdominal blunt injury 2 months before admission presented with a newly developed, massive pleural effusion and clinical manifestations of intestinal obstruction. A multidetector-row computed tomography confirmed the diagnosis of traumatic diaphragm rupture and TDIH. He underwent thoracotomy with reduction of herniated viscera and repair of the diaphragm and chest wall. He was discharged uneventfully and remained well on follow-up at 2 months.
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