Transdiaphragmatic intercostal hernia: imaging aspects in three cases

Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.

Hernia, diaphragmatic; Radiography; Ultrasonography; Tomography; Magnetic resonance imaging

Authorship

Ana Carolina Sandoval Macedo

Hospital Israelita Albert Einstein, São Paulo, BrazilHospital Israelita Albert EinsteinBrazilSão Paulo, BrazilHospital Israelita Albert Einstein, São Paulo, Brazil

Fernando Uliana Kay

Hospital Israelita Albert Einstein, São Paulo, BrazilHospital Israelita Albert EinsteinBrazilSão Paulo, BrazilHospital Israelita Albert Einstein, São Paulo, Brazil

Ricardo Mingarini Terra

University of São Paulo, School of Medicine, Department of Thoracic Surgery, São Paulo, BrazilUniversity of São PauloBrazilSão Paulo, BrazilUniversity of São Paulo, School of Medicine, Department of Thoracic Surgery, São Paulo, Brazil

José Ribas Milanez de Campos

André Galante Alencar Aranha

Fundação Lusíada, School of Medicine, Department of Thoracic SurgeryFundação LusíadaFundação Lusíada, School of Medicine, Department of Thoracic Surgery

Methodist University at Santos, School of Medicine, Respiratory Tract Department, Santos, BrazilMethodist University at SantosBrazilSantos, BrazilMethodist University at Santos, School of Medicine, Respiratory Tract Department, Santos, Brazil

Marcelo Buarque de Gusmão Funari

Hospital Israelita Albert Einstein, Imaging Department, São Paulo, BrazilHospital Israelita Albert EinsteinBrazilSão Paulo, BrazilHospital Israelita Albert Einstein, Imaging Department, São Paulo, Brazil

Correspondence to: Ana Carolina Sandoval Macedo. Avenida Albert Einstein, 627, 4Âº andar, Bloco D, Morumbi, CEP 05652-900, São Paulo, SP, Brasil. Tel. 55 11 2152-2452. Fax: 55 11 2152-2452. E-mail: ana.smacedo@einstein.br

SCIMAGO INSTITUTIONS RANKINGS

Hospital Israelita Albert Einstein, São Paulo, BrazilHospital Israelita Albert EinsteinBrazilSão Paulo, BrazilHospital Israelita Albert Einstein, São Paulo, Brazil

Fundação Lusíada, School of Medicine, Department of Thoracic SurgeryFundação LusíadaFundação Lusíada, School of Medicine, Department of Thoracic Surgery

Figures

Figures (3)

Thumbnail

Figure 1
In A, posteroanterior chest radiograph. The arrow demonstrates opacification at the base of the right hemithorax, interspersed with some gas images. The arrowhead indicates soft tissue swelling in the periphery of the right lateral chest wall, with some gas images similar to those observed at the base of the right hemithorax. In B, coronal reconstruction of a noncontrast CT scan of the chest showing herniation of abdominal content into the base of the right hemithorax through the diaphragm (arrow), as well as through the eighth intercostal space (asterisk), headed toward the subcutaneous tissue of the chest wall. Note the presence of thin loops in the subcutaneous tissue of the chest wall (arrowhead).

Thumbnail

Figure 2
In A, photograph showing visible bulging of the region of the right eighth intercostal space, on examination of the chest wall. In B, surface ultrasound examination of the region demonstrating a formation with echotexture similar to that of the liver, extending beyond the musculoskeletal boundaries of the chest wall and occupying the subcutaneous region (arrows). In C and D, axial CT slices of the upper abdomen demonstrating that part of hepatic segment V protruded through the area of muscle discontinuity, headed toward the adjacent subcutaneous region.

Thumbnail

Figure 3
In A, posteroanterior chest radiograph demonstrating opacification at the base of the right hemithorax, superiorly displacing the lung parenchyma (white arrow). Note the widening of the eighth intercostal space and the presence of a structure with gas density, similar to an intestinal loop, occupying the soft tissues of the adjacent chest wall (black arrow). In B, axial CT image of the chest, where it is possible to observe the passage of epiploic fat into the base of the right hemithorax and subcutaneous tissue of the chest wall (asterisk). Note the presence of a fracture of the ninth rib (white arrow). In C, coronal T1-weighted non-fat-saturated magnetic resonance image demonstrating the presence of a large amount of abdominal fat herniated into the base of the right hemithorax. Note the discontinuity of the intercostal muscles (black arrow), through which the content herniates into the subcutaneous tissue of the chest wall. In D, photograph showing the main surgical finding: a rent in the anterolateral portion of the diaphragm.

Figure 1 In A, posteroanterior chest radiograph. The arrow demonstrates opacification at the base of the right hemithorax, interspersed with some gas images. The arrowhead indicates soft tissue swelling in the periphery of the right lateral chest wall, with some gas images similar to those observed at the base of the right hemithorax. In B, coronal reconstruction of a noncontrast CT scan of the chest showing herniation of abdominal content into the base of the right hemithorax through the diaphragm (arrow), as well as through the eighth intercostal space (asterisk), headed toward the subcutaneous tissue of the chest wall. Note the presence of thin loops in the subcutaneous tissue of the chest wall (arrowhead).

Figure 2 In A, photograph showing visible bulging of the region of the right eighth intercostal space, on examination of the chest wall. In B, surface ultrasound examination of the region demonstrating a formation with echotexture similar to that of the liver, extending beyond the musculoskeletal boundaries of the chest wall and occupying the subcutaneous region (arrows). In C and D, axial CT slices of the upper abdomen demonstrating that part of hepatic segment V protruded through the area of muscle discontinuity, headed toward the adjacent subcutaneous region.

Figure 3 In A, posteroanterior chest radiograph demonstrating opacification at the base of the right hemithorax, superiorly displacing the lung parenchyma (white arrow). Note the widening of the eighth intercostal space and the presence of a structure with gas density, similar to an intestinal loop, occupying the soft tissues of the adjacent chest wall (black arrow). In B, axial CT image of the chest, where it is possible to observe the passage of epiploic fat into the base of the right hemithorax and subcutaneous tissue of the chest wall (asterisk). Note the presence of a fracture of the ninth rib (white arrow). In C, coronal T1-weighted non-fat-saturated magnetic resonance image demonstrating the presence of a large amount of abdominal fat herniated into the base of the right hemithorax. Note the discontinuity of the intercostal muscles (black arrow), through which the content herniates into the subcutaneous tissue of the chest wall. In D, photograph showing the main surgical finding: a rent in the anterolateral portion of the diaphragm.

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Transdiaphragmatic intercostal hernia: imaging aspects in three cases

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[1] Correspondence to: Ana Carolina Sandoval Macedo. Avenida Albert Einstein, 627, 4Âº andar, Bloco D, Morumbi, CEP 05652-900, São Paulo, SP, Brasil. Tel. 55 11 2152-2452. Fax: 55 11 2152-2452. E-mail: ana.smacedo@einstein.br