Cáceres’ Corner Case 255

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.

17 thoughts on “Cáceres’ Corner Case 255

  1. 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

  2. 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?

  3. 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

  4. 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?

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