Radiology Quiz

14 December, 2007 at 2:23 pm gcgeorge 8 comments

Give it your best shot!

An elderly lady claimed to have fell off a chair hitting the back of her head on the floor. She was seen in Emergency Department and was told to be well. 2 weeks later, she was having difficulty in breathing and also had episodes of vomiting which did not allow her to eat. Everytime she eats she vomits. These were her Xrays and Ct scans.

Any takers?

Medical none

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Written by Paddy on 14 December, 2007.

(A) Boerhaves Syndrome

or

(B) Diaphragmatic Rupture
Written by Tiny Shrink on 14 December, 2007.

Diaphragmatic rupture or incarcerated paraesophageal hiatal hernia
Written by Vijay on 15 December, 2007.

My first impression when I saw the Chest xray & the digital scanogram was that it is a diaphragmatic palsy.
The xrays, scanogram and the axial CT images are not typical for a traumatic diaphragmatic rupture.
The shape of the air-filled stomach appears normal. There is no constriction, which should’ve been there if it had herniated into the thorax through a rent in the diaphragm. Of course, the stomach would appear normal if the rent was large enough to let it pass into the chest without constriction. But then the pleural effusion and intrathoracic changes ought to have been more severe. Why is there so much of gas dilatation of the small bowel?
I wonder if it is just a traumatic phrenic nerve palsy? Given the h/o vomiting, I would also think of some kind of vagal injury.
I know I’m out on a limb here. I’ll wait for your denouement George.
Written by Bongi on 16 December, 2007.

i’m going to go with rupture. even chronic.
Written by Bai on 17 December, 2007.

C4 injury
Written by George on 17 December, 2007.

well thanks all. Looks like Vijay got it right. It is a diaphragmatic palsy. Her history only begins after the fall thus suggesting a traumatic cause. The obstruction was due to the anatomical displacement of the upper gastrointestinal tract together with adhesion formation . Therefore, surgery was indicated where the plication of the paralysed diaphragm was done and the stomach was returned to position. She recuperated well and was discharged well after a week.
Written by George on 17 December, 2007.

MRI of her cervical spine was normal
Written by Vijay on 18 December, 2007.

)

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