Original articleDiaphragmatic Hernias: A Spectrum of Radiographic Appearances
Section snippets
Diaphragmatic Development and Anatomy
The embryologic development of the diaphragm remains incompletely understood. Between the 4th and 12th weeks of gestation, 4 elements converge to form the fetal diaphragm:1 the septum transversum (a mass of pluripotent mesoderm), pleuroperitoneal membranes, dorsal mesentery of the esophagus, and body wall musculature. Forming first in the cervical area, the septum transversum descends caudally by the eighth week of gestation, coordinated with sternal fusion and opposed by a rapid increase in
Congenital Diaphragmatic Hernias
The development of the diaphragmatic musculature creates potential gaps in predictable locations that are covered only by connective tissue and not infrequently allow for herniation of abdominal contents during fetal development, after birth, or in adulthood. Diagnoses that will be discussed are fetal diaphragmatic hernias, Bochdalek and Morgagni hernias, and diaphragmatic eventration. Presentation ranges from massive life-threatening hernias detected in utero to a small defect with herniation
Acquired Diaphragmatic Hernias
Herniation can also occur through developmentally normal diaphragm, without predisposing weakness, because of trauma or degeneration. Diaphragmatic hernias to be discussed in this category include hiatal hernia and traumatic diaphragmatic rupture.
Conclusions
Diaphragmatic hernias are frequently encountered in almost any radiologic practice. Differentiation of potentially life-threatening diagnoses from incidental and benign findings or other mimics is essential to effectively and efficiently triage patients, guide further workup, and assist the consulting surgeon in treatment planning.
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2022, International Journal of Surgery Case ReportsCitation Excerpt :Possible mechanisms include lateral impact resulting in distortion and shear-stress on the chest wall and diaphragmatic attachments versus direct frontal impact causing sudden increase in intraabdominal pressure. Due to the indirect mechanism of injury with blunt trauma, most patients will have other significant and potentially distracting or life-threatening injuries, such as hepatic, splenic, or pancreatic injuries and renal lacerations, pelvic fractures, and aortic injuries [4]. Ruptures tend to occur at the central tendon or at the boundary between the tendinous and muscular part of the diaphragm.
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2019, ChestCitation Excerpt :However, a delayed presentation of CDH in adults is known and it may be because of the acquired weakness of a preexisting developmental defect in the diaphragm. With a prevalence of 0.17% to 6% in adults,2 Bochdalek hernia is the most common type (usually develops on the left side posterolaterally), followed by Morgagni hernia (usually retrosternal).3 The presentation of CDH in adults is nonspecific, and often the diagnosis is made incidentally on CT scan performed for unrelated indications.