Radiology Quiz
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?
December 14th, 2007 at 2:55 pm
(A) Boerhaves Syndrome
or
(B) Diaphragmatic Rupture
December 14th, 2007 at 7:30 pm
Diaphragmatic rupture or incarcerated paraesophageal hiatal hernia
December 15th, 2007 at 11:53 am
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.
December 16th, 2007 at 12:23 pm
i’m going to go with rupture. even chronic.
December 17th, 2007 at 4:50 am
C4 injury
December 17th, 2007 at 7:31 pm
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.
December 17th, 2007 at 7:32 pm
MRI of her cervical spine was normal
December 18th, 2007 at 8:43 am
:o)