Dear friends,
today I am presenting preoperative chest radiographs for knee surgery in a 47-year-old woman.
More images will be shown on Wednesday.
What do you see?
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Findings: PA chest radiograph shows a bump in the left hemidiaphragm (A, arrow). It is partially hidden in the lateral view by the shadow of the right hemidiaphragm and the cardiac silhouette (B, arrows).
Diaphragmatic bumps are common on the right and rarer on the left, especially in young persons. I was curious about this finding and reviewed an abdominal CT done a few weeks earlier. Enhanced axial, coronal and sagittal images demonstrate an intact diaphragm and a fluid-filled structure in the thoracic side (C-E, arrows). The appearance is typical of a diaphragmatic cyst.
Diaphragmatic cyst is a congenital lesion, asymptomatic and absolutely harmless. It is easy to demonstrate with CT and should not be removed. They are rare (I have seen only four during my professional life). I thought it interesting to acquaint you with this rare entity.
Final diagnosis: congenital diaphragmatic cyst
Teaching point: not all diaphragmatic bumps are hernias or eventrations. When they occur in the left side in a young person, consider other possibilities, such as a congenital cyst or a fibrous pleural tumor.
There is elevation of the left dome of diaphragm with an upward convex opacity silhouetting the left dome of diaphragm . B/ L CP angles clear . Cardiac size is normal
I would tip on diaphragmatic eventration or left sided Morgagni hernia.
I would like a Morgagni hernia to be closer to the cardiophrenic angle and more anterior in the lateral view.
Sensible diagnosis with only the PA view. Does the lateral help? (it was lost in the hyperspace and now has returned 🙂
Hump left dome of diaphragm, but gas bubble is seen in normal intraabdominal position.
Otherwise eventration would have been my first choice.
Subdiaphragmatic loculated collection, but Lt CP angle clear so no acute infection.
Spleen herniating?
Left diaphragm mass?
Wait for CT images tomorrow
Good morning!!
In an asymptomatic patien I think in lobulated hemidiaphgram see in both proyections or pleural lesion (probably bening-fibrous tumor).
Prominent vascular hilus
Hypodense pleural lesion with intraabdominal perisplenic and pericolic fluid… Any relevant personal history? I think about mucinous origin or an acute abdominal process but is the patient asymptomatic?
The patient had a recent laparoscopy. No relationship with the chest lesion.
The patient is asymptomatic.
So pleural fibrous tumor is an option…
It is if you disregard the density of the lesion 🙂
Any previous episode of acute pancreatitis?
No
I think I would ask her if she thoroughly washes her vegetables before eating them.
I am baffled! What are thinking of?
I was thinking of the possibility of a hydatid cyst.