右侧膈疝的X线诊断

Radiologic Diagnosis of Right Diaphragmatic Hernia

右侧膈疝较左侧膈疝少见,其原因主要是右膈下有肝脏对膈肌起保护作用。本院自1960年至1980年共收治6例,均经手术证实,其中先天性4例,占66.7%’外伤性2例,占33.3%。本病术前正确诊断比较困难,尤其是部分肝脏疝入右侧膈上.

Six cases of right-sided diaphragmatic hernia(4 congenital and 2 traumatic)confirmed by operation were described.The age of onset was from 6 months to 45 years.In 4 cases of intestinal herniation into the right hemithorax,the radiograph appearances in the lower right lung field area were a mass-like shadow of irregularly distributed density with different sized transparent areas,and an unclear right dia-phragm shadow.In 3 of the 4 cases the shadow of gass-containing intestines was reduced with deviation to the right upper quadrant of the abdomen.Barium meal confirmed that the shadow of the right lower thorax was caused by intestinal herniation.In 2 cases of herniation of the liver through the right diaphragm,roentgeno-grams showed on the right diaphragm a local mass-like shadow of well distributed density semicircular in shape,reduction of liver shadow,and deviation of the intestines to the right.A pneumopyothorax on the right side was seen in artificial pneumo-peritoneum.The incidence and mechanism of the right diaphragmatic hernia were analysed and discussed on the basis of operation and x-ray findings,and differential diagnosis were also described in the paper.