title: Delayed traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade.
abstract: We describe a case of delayed presentation of traumatic intrapericardial diaphragmatic hernia associated with cardiac tamponade. A 71-year-old woman presented to our emergency department complaining of epigastric and midabdominal pain one month after hospitalization for multiple injuries suffered in an automobile accident. Chest radiograph showed a diaphragmatic hernia. In the ED, the patient became hypotensive and tachycardic with elevated central venous pressure. At surgery, she was found to have omentum and transverse colon herniated into the pericardial sac causing cardiac tamponade. The defect was repaired, and her postoperative course was uncomplicated. Cardiac tamponade should be included in the differential diagnosis of hypotension in patients with radiographic evidence of diaphragmatic hernia.
authors.affiliation: Emergency Medicine Residency Program, Christ Hospital and Medical Center, Oak Lawn, Illinois 60465.
authors.forename: D V
authors.initials: DV
authors.lastname: Girzadas
authors.forename: D J
authors.initials: DJ
authors.lastname: Fligner
mesh_terms: D000368:Aged; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007022:Hypotension / Q000209:etiology; D010146:Pain / Q000209:etiology; D011859:Radiography; D013997:Time Factors