Diaphragmatic Hernia

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     A 76-year-old man was referred to our hospital because of hemoptysis. He had had pulmonary tuberculosis six years before his current admission, and he had had an abnormal chest radiograph during adolescence. A chest radiograph showed an opacity in the right hemithorax that was accompanied by numerous masses, each surrounded by an air crescent (Panel A). Bowel sounds were heard over the right chest, and a barium enema showed that the colon filled the right hemithorax (Panel B). Computed tomography suggested hypoplasia of the right lung and herniation of the bowel through the posterior diaphragm (Panel C). Bronchoscopic examination showed no bleeding in any of the bronchial lumina or orifices. Examination of the sputum yielded no specific pathogens or malignant cells, and the hemoptysis ceased spontaneously. Follow-up on an outpatient basis without specific therapy was planned. Since the patient's history did not include a traumatic accident, the radiographic findings were compatible with a diagnosis of congenital diaphragmatic hernia.

    Reiko Fukamizu, M.D.

    Seiji Hayashi, M.D., Ph.D.

    National Hospital Organization

    Kinki-Chuo Chest Medical Center

    Osaka 591-8555, Japan

    http://www.100md.com/html/DirDu/2006/11/29/30/37/32.htm