James Michael Forsyth vascular surgery registrar, Shariq Sabri general surgical registrar, Abduljalil Benhamida upper gastrointestinal tract consultant surgeon
Forsyth J M, Sabri S, Benhamida A.
Massive diaphragmatic hernia causing shortness of breath and abdominal pain
BMJ 2015; 351 :h5429
doi:10.1136/bmj.h5429
Re: Massive diaphragmatic hernia causing shortness of breath and abdominal pain
Still on clinical;
A. Were there cardiac tamponade signs...small pulse, distended jugular veins, low pressure
B. Was there mediastinal shift...... apex beat, tracheal shift
C. Was there contra lateral pulmonary compression.....poor air entry, adventitious sounds from collapse or atelectasis
D. Was there associated ppleuritis from chronic friction.........pleural rub on auscultation
E. Was there sign of chronic pulmonary insufficiency apartfrom breathlessness....mucosal perfusion or color,acral perfusion a color
F were there compensatory anatomic changes in thoracic form....... ....symmetry,lateralisations
G. Were there compensatory changes in abdominal forms or topographic anatomy......transverse or longitudinal diameters or even sagittal diameters
H. On palpation, were there abdominopelvic compensatory organ shifts .
These clinical features could provide additional evidence of chronicity and both loco regional and systemic impact of such massive herniation
Competing interests: No competing interests