Kim E E, McConnell B J, McConnell R W, Duke J H, Dillon M
Surgery. 1983 Jul;94(1):36-40.
Seven surgically proven cases of a traumatic rupture of the right hemidiaphragm with a hepatic herniation were preoperatively diagnosed by radionuclide liver-spleen imagings, and they were retrospectively analyzed. All injuries resulted from blunt traumatic injury including automobile accidents, and there were associated pelvic and rib fractures in five cases. All patients developed some degree of dyspnea in the relatively immediate phase. All chest radiographs showed an apparent elevation of right hemidiaphragm. Radionuclide liver-spleen imaging with 99mTc sulfur colloid characteristically demonstrated a distortion of liver configuration with superior and posterior displacement of the right lobe. Four patients had a large tear in the central tendon of the right hemidiaphragm, and none had a tear in the anterior part or in left lobe of the liver. The differential diagnosis of elevated right hemidiaphragm is briefly discussed. It is concluded that the correct preoperative diagnosis of the diaphragmatic rupture with liver hernia could be made with an awareness of this condition following trauma and radionuclide liver-spleen imaging.
七例经手术证实的右侧膈破裂伴肝脏疝出的病例术前通过放射性核素肝脾显像得以诊断，并进行了回顾性分析。所有损伤均由钝性创伤所致，包括汽车事故，五例伴有骨盆和肋骨骨折。所有患者在相对较短时间内均出现了不同程度的呼吸困难。所有胸部X线片均显示右侧膈明显抬高。用99m锝硫胶体进行放射性核素肝脾显像的特征是肝脏形态扭曲，右叶向上和向后移位。四名患者右侧膈中心腱有大的撕裂，无一例肝脏前部或左叶有撕裂。简要讨论了右侧膈抬高的鉴别诊断。得出的结论是，在创伤后意识到这种情况并结合放射性核素肝脾显像，可对膈破裂伴肝脏疝做出正确的术前诊断。
