Ann Thorac Surg 2002;74:1714
© 2002 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Intrathoracic stomach or empyema?
Richard van Hillegersberg, MD, PhDa,b*,
Lenoud C.W. de Jonge, MDa,b,
Johan S. Laméris, MD, PhDa,b,
Jan J.B. van Lanschot, MD, PhDa,b
a Department of Surgery and Radiology, University of Amsterdam, Amsterdam, The Netherlands
b Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
* Address reprint requests to Dr van Hillegersberg, Department of Surgery, G4-114, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
e-mail: r.vanhillegersberg{at}amc.uva.nl
A 61-year-old man was seen at the emergency department with left-sided thoracic pain and dyspnea without fever. One month earlier, he had undergone an operation for a suprarenal aortic aneurysm with partial transection of the left diaphragm. Postoperatively, the pleural cavity was drained for several days. Roentgenograms of the thorax showed a left-sided air- and fluid-filled cavity resembling an intrathoracic stomach (Figs A and B).
The differential diagnosis included iatrogenic diaphragmatic hernia or pleural empyema. Radiologically, the large diameter of the cavity wall and the close contact with the posterior aspect of the thorax pointed more toward an empyema. The diagnosis of thoracic empyema after thoracoabdominal aortic aneurysm repair was established by a contrast-enhanced computed tomographic scan that clearly identified the pleural empyema (Fig C) and subdiaphragmatic stomach. The collection was effectively drained percutaneously.
For comparison, we show a lateral chest roentgenogram from another patient with a paraesophageal diaphragmatic hernia and intrathoracic stomach (Fig D). This patient received oral administration of contrast medium, which remained in the subdiaphragmatic cardia of the strangulated stomach. The intrathoracic part of the stomach has an air-fluid level but also has a much thinner wall and less contact with the posterior chest wall.
