Traumatic Intrapericardial Diaphragmatic Hernia: Diagnostic Challenges and the Role of Multimodal Evaluation.
Mouktik Bandi, Christian R Schuetz, Alfredo C Cordova et al.
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Case in brief
A 71-year-old woman presented with chest pain and dyspnea following a motor vehicle collision. Initial imaging revealed rib, liver, and pelvic fractures but did not show diaphragmatic injury. After orthopedic surgery, repeat imaging indicated an intrapericardial diaphragmatic hernia (IPDH). Robotic-assisted repair uncovered a 9-cm diaphragmatic defect containing stomach and omentum. Postoperative evaluation confirmed pericarditis.
Diagnostic / clinical pearl
Clinicians should be aware that intrapericardial diaphragmatic hernia can present with nonspecific symptoms and subtle imaging findings, necessitating a high index of suspicion and multimodal evaluation.
Why it matters
This case underscores the importance of timely surgical intervention in managing IPDH, as delayed diagnosis can lead to complications such as pericarditis.