Cross-Sectional CT of Strangulating Intrapericardial Diaphragmatic Hernia
Donald J. Wenzel1,2 and
Jackson D. Hamilton3
1
Department of Radiology, Durham Veteran Affairs Medical Center, 508 Fulton
St., Durham, NC 27705.
2
Present address: Department of Radiology, Medical College of Georgia, 1120
15th St., Augusta, GA 30912.
3
University of North Carolina at Chapel Hill Medical School, Rm. CB7525, Chapel
Hill, NC 27516.
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Fig. 1A. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Frontal chest radiograph obtained 6 days after onset of
symptoms shows cardiac dimensions are increased from prior examination (not
shown). Note apparent double density at right heart contour (horizontal
arrows), bowel gas projecting over left heart (vertical arrows),
and healed displaced right rib fractures (curved arrows).
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Fig. 1B. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Lateral chest radiograph (companion to A) shows
bowel loop projecting into anterior mediastinum (straight arrows) and
fluid density anterior to subepicardial fat stripe (curved
arrows).
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Fig. 1C. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Enhanced helical CT scan 2 weeks after onset of symptoms
shows heart is completely surrounded by thick pad of fluid and fat with
increased density and heterogeneity. Note engorged vessels (curved
arrow), dependent effusion (open arrow), and subepicardial fat
(small arrows).
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Fig. 1D. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Enhanced helical CT scan (same as C but at level of
diaphragm) shows enlarged enhanced central vessels traverse large left
anterior paracentral defect in diaphragm (arrows). Pleural effusion
(P) was new, as was liver lesion (M), consistent with metastasis.
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Fig. 1E. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Enhanced helical CT scan 15 months earlier, during
asymptomatic period. Excessive intrapericardial fat, identical in density to
fat elsewhere, appears confined by only two membranes. No peritoneal sac is
seen. Note smooth nonlobular contour of mediastinum.
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Fig. 1F. —78-year-old man with progressive dyspnea caused by enlarging
pericardial hernia. Enhanced helical CT scan (same as E but at level of
diaphragm). Note smaller (6 x 8 cm) diaphragmatic defect
(arrows) and smaller contained vessels.
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Copyright © 2001 by the American Roentgen Ray Society.
