Mediastinal Mass and Air Bubble in Two Elderly Patients

Diaphragmatic hernia is a defect of the diaphragm that causes migration of abdominal contents to the chest cavity. Because a diaphragmatic hernia can mimic a mediastinal mass, a chest X-ray showing an intrathoracic air bubble is an important diagnostic indicator of this disease. In the two elderly patients with diaphragmatic hernia reported here, however, initial posteroanterior chest X-rays did not show this typical finding. Diaphragmatic hernia was not suspected until follow-up, when a further posteroanterior chest X-ray showed an intrathoracic air bubble. The diagnosis of diaphragmatic hernia was further confirmed by the chest computed tomography scan. However, surgical repair was refused in both cases, and medical treatment was limited to relief of symptoms. Copyright (C) 2013, Taiwan Society of Geriatric Emergency 82 Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.