Magu Sarita, Agarwal Shalini, Jain Nitin, Dalal Nityasha
Department of Radiology, Pt BD Sharma, PGIMS, Rohtak, Haryana, India.
BMJ Case Rep. 2013 Aug 1;2013:bcr2012008547. doi: 10.1136/bcr-2012-008547.
Detection of diaphragmatic hernia in the acute setting is problematic and diagnosing diaphragmatic hernia as hydropneumothorax is not an uncommon mistake. We present a series of four such cases diagnosed over a 7-year period, from December 2004 to January 2011 and analyse them for how this mistake can be avoided. In case of all the patients reported by us the initial radiographs were technically compromised because the patient could not be positioned properly. Also they were examined by non-radiologists. We feel that treating surgeons in emergency department tend to overdiagnose pneumothorax as it is a life-threatening condition. We feel that in the appropriate setting suspicion of diaphragmatic hernia should be raised in patients having fractured ribs associated with homogenous opacity, which cannot be differentiated from the diaphragm. Evidence of loculation of hydropneumothorax in the appropriate setting should also raise the possibility of diaphragmatic hernia.
在急性情况下，膈肌疝的检测存在问题，将膈肌疝误诊为液气胸并非罕见的错误。我们呈现了2004年12月至2011年1月这7年间诊断出的4例此类病例，并分析如何避免这一错误。在我们报告的所有患者中，最初的X线片在技术上存在缺陷，因为患者无法正确定位。而且这些片子是由非放射科医生检查的。我们认为急诊科的主治外科医生往往会过度诊断气胸，因为它是一种危及生命的疾病。我们认为，在适当的情况下，对于伴有与膈肌无法区分的均匀性混浊的肋骨骨折患者，应怀疑有膈肌疝。在适当情况下出现液气胸分隔的证据也应增加膈肌疝的可能性。
