Cardiomegaly and Pectus Excavatum

Cardiomegaly and Pectus Excavatum

I ROENTGENOGRAM OF TilE MONTH Cardiomegaly and Pectus Excavatum K. K. Hunt, ]r., Ltc, MC, USA • and R. Cole, Ma;, MC, USA • • This 21-year-old man ...

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I

ROENTGENOGRAM OF TilE MONTH

Cardiomegaly and Pectus Excavatum K. K. Hunt, ]r., Ltc, MC, USA • and R. Cole, Ma;, MC, USA • •

This 21-year-old man presented for evaluation of cardiomegaly noted on a chest roentgenogram obtained because of palpitation. He had no other symptom of heart disease and his physical examination was normal except for a moderate pectus excavatum deformity.

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•From the Pulmonary Disease Service, Madigan Army Medical Center, Tacoma. .. From the Department of Surgery, Basset Army Hospital, Ft. Wainwright, Alaska. Reprint requests: Dr. Hunt, Ben 246, Madigan Hospital, Tacoma98431

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CHEST, VOL. 64, NO. 4, OCTOBER, 1973

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HUNT, COLE

Diagnosis: Retrostemal Diaphragmatic Herniation of the Liver Figure 1 demonstrates increased cardiothoracic ratio and Figure 2 shows the pectus excavatum. In the lateral view, an increased density overlies the cardiac silhouette, producing a double density. An anterior radioisotopic liver scan (Fig 3) reveals a large amount of liver tissue projecting above the right hemidiaphragm. The diagnosis was confirmed at .thoracotomy which was undertaken in an attempt to correct the hernia. Due to technical difficulties, however, reduc-

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tion was not accomplished. The patient had a benign postoperative course and resumed full activity. Herniation of liver tissue into the thoracic cavity is well known. It may occur after trauma, 1•2 spontaneously, or as a congenital anomaly.M Our case is of interest because the hepatic hernia simulated cardiomegaly and there was no history of trauma. The enlarged cardiac silhouette was initially attributed to anteroposterior compression of the heart by the pectus deformity. However, such patients usually show little, if any, cardiac silhouette to the right of the spine. is usually he~1} Nontraumatic diaphra~a~ found at the esophageal hiatus · or~ at the sites of congenital weakness, such as the posterolateral foramina of Bochdalek and the retrosternal foramina of Morgagni. The liver is an unusual component of such hernias. When hepatic herniation is suspected, a radioisotopic liver scan is an easy and safe way to confirm the diagnosis. Surgery may or may not be indicated, depending upon the clinical situation.

1 Geller P, Fogle HW: Asymptomatic right lower thoracic mass. Chest 60:183-184, 1971 2 Leung WM, Guilfoil PH: Traumatic rupture of right hemidiaphragm. Chest 52:243-244, 1967 3 Poe RH, Schowengerdt CG: Two cases of atraumatic herniation of the liver. Am Rev Resp Dis 105:959-963, 1972 4 Epstein RL, Hall RV, Gillespie ]T, et al : Asymptomatic right lower thoracic)1odule. Chest 62:741-742, 1972

Training Programs in Respiratory Disease The American Lung Association and its medical section, the American Thoracic Society, have published the 8th edition of "Training Programs in Respiratory Disease." Included is the 7th edition of Pediatric Programs. The booklet contains such information as: institution, chief of service or program director, affiliation, previous training required, annual stipend, type of experience offered, facilities, inpatient and outpatient admissions per year. The listing carries no implication of approval

by the American Lmg Association/ American Thoracic Society. The information is purely factual as supplied by · those in charge of the programs. The booklet is reprinted from the August, 1973 issue of the American Review of Respiratory Disease. Copies may be obtained from the American Lung Association, 1740 Broadway, New York, Medical AHairs Divis~on, N.Y.10019.

CHEST, VOL. 64, NO. 4, OCTOBER, 1973