Diaphragmatic Hernia

A 71-year-old woman was brought to the hospital with blunt abdominal trauma suffered in an automobile accident. She complained of pain in the chest and abdomen.

A nasogastric tube was inserted. The chest film revealed that the end of the nasogastric tube coiled at the left heart border (arrow)-a most unexpected finding. The diagnosis of rupture of the left hemidiaphragm was confirmed by the axial CT, which showed the stomach adjacent to the heart and the nasogastric tube.

Robert P. Blereau, MD of Morgan City, La, writes that a large hiatal hernia could be depicted similarly on a chest film; however, the nasogastric tube would be expected to be in a more medial position.

This patient's diaphragmatic hernia was repaired after the stomach was reduced into the abdominal cavity via a thoracoabdominal incision. Her postoperative course was uneventful.