The Value of the Routine Chest X-ray Film in Detecting Diaphragmatic Hernia; A Report of 53 Cases

¹ The Tuberculosis Control Service, Manteno State Hospital, Department of Welfare, Manteno, Illinois.

1. The routine chest x-ray is useful in the diagnosis of diaphragmatic hernia.

2. The finding of an enlarged square-shaped or globular heart silhouette containing a large air pocket with or without a horizontal fluid level, is virtually diagnostic of hiatal hernia.

3. Small faint air bubbles or streaks of air along the right or left borders of the heart should also be suspected of hiatal hernia.

4. The ovoid elongated homogeneous shadow that produces variations in density within the cardiac silhouette is usually due to a hiatal hernia.

5. Any massive shadow within the lung field, continuous with the diaphragmatic outline and obscuring it, or any shadow in which the continuity is incomplete above the diaphragm, is suspicious of diaphragmatic hernia of the Morgagni type or one of traumatic origin.

6. The use of the barium meal and/or barium enema is obligatory for the final confirmation of the suspected condition.

7. Diagnostic pneumoperitoneum may be employed in those cases wherein herniation of omentum or part of the liver is suspected.