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Diaphragmatic (Bochdalek) hernias simulating pulmonary metastases on computed tomography
A P Brooks1, A McLean, R H Reznek
1Department of Diagnostic Radiology, St Bartholomew's Hospital, London.
Clinical Radiology
|August 1, 1990
Summary
Small abdominal fat herniations can mimic lung tumors on CT scans in patients with cancer. These diaphragmatic defects present as solitary lesions, requiring careful radiologic interpretation to avoid misdiagnosis.
Area of Science:
- Radiology
- Thoracic Surgery
- Oncology
Background:
- Patients with known primary malignancy often undergo imaging surveillance.
- Chest radiography is a common initial screening tool.
- Computed tomography (CT) is used for detailed thoracic evaluation.
Observation:
- Three patients with malignancy and normal chest radiographs were evaluated.
- CT scans revealed solitary mass lesions in the posterior costophrenic recess.
- These lesions mimicked neoplastic masses on lung-optimized CT views.
Findings:
- The observed lesions were identified as small herniations of abdominal fat.
- Herniation occurred through congenital or acquired defects in the diaphragm.
- This finding highlights a potential imaging pitfall in cancer patients.
Implications:
- Accurate differentiation of fat herniation from metastatic disease is crucial.
- Understanding diaphragmatic anatomy and potential defects aids diagnosis.
- Avoidance of unnecessary invasive procedures or treatments is essential.