Intrapericardial Diaphragmatic Hernia

An adult male presented to the emergency department complaining of two days of exertional shortness of breath and progressive chest pain. He was afebrile with a blood pressure of 135/88 mmHg, heart rate of 105 beats/minute, respiratory rate of 22 breaths/minute, and a SaO2 of 94% on room air. There was no history of preceding trauma, surgery or known congenital defects. A chest radiograph demonstrated an enlarged cardiac silhouette (Figure 1). Computed tomography revealed the presence of herniated visceral contents within the pericardial sac (Figure 2). Surgery was consulted for operative repair of this intrapericardial diaphragmatic hernia (IPDH), which was causing his presenting symptoms. IPDH can occur from a traumatic or congenital diaphragmatic defect of the central tendon. It is a rare complication of diaphragmatic rupture, occurring in less than 1% of cases.1,2 Blunt trauma resulting from automobile collisions has emerged as the most common primary identified cause.3 The mechanism in blunt abdominal trauma involves