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A 17yo girl presents with LUQ abdominal pain and vomiting x 2 days, and SOB x 1 day. Past medical history includes mild intermittent asthma, treatment for community-acquired pneumonia one month ago, and an MVA 1 year ago – she received head CT that was negative and was admitted and observed overnight at that time. Her CXR is below.
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February 11, 2020 at 5:18 pm
A) It is likely due to her prior trauma
The CXR depicts a diaphragmatic hernia. The most common cause of acquired diaphragmatic hernia is trauma, usually blunt, and it can present months to years after the trauma event. Congenital diaphragmatic hernia can rarely have a delayed presentation, but usually would present in the first few years of life. Pneumomediastinum and pneumothorax could complicate asthma, but these are not present. A lung abscess could complicate pneumonia, but the CXR shows the stomach up in the chest, not a lung abscess. Traumatic diaphragmatic hernia is much more common on the left. It typically presents with chest and/or upper abdominal pain, SOB, and vomiting.