Diaphragmatic eventration and Chilaiditi sign

Case contributed by Craig Hacking
Diagnosis certain

Presentation

Funny turn.

Patient Data

Age: 90 years

Left-sided double lead pacemaker device remains well positioned and the leads intact. The lungs and pleural spaces are clear. No pneumothorax. No signs of pulmonary edema. Heart size is enlarged even allowing for projection. Right hemidiaphragm eventration containing large bowel is unchanged. No mediastinal contours and hila are normal. No free subdiaphragmatic gas. The lower thoracic crush fracture has reduced in height slightly more since the previous study.

Case Discussion

A segment of the large bowel is seen beneath the right diaphragmatic eventration, which may mimic pneumoperitoneum (pseudopneumoperitoneum). The other differential for this case is a cavitation lung lesion such as lung cancer or abscess if the patient was sick.

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