© 2003 Fellowship of Postgraduate Medicine
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An elderly man with chest pain, shortness of breath, and constipation
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The upright posteroanterior and lateral films (see p 180) show a marked elevation of the right hemidiphragm with distended loops of bowel interposed between the liver and right abdominal wall. Haustration identifies the large bowel, distinguishing colonic hepatodiaphragmatic interposition from subphrenic pneumoperitoneum or abscess. The lung fields and pleural spaces are clear. Note the normal heart size and median sternotomy wires. Interestingly, the hepatodiaphragmatic interposition of the right colon had not been seen on films taken five and seven years previously, but persisted after complete resolution of the symptoms and was still present on follow up two weeks later. The computed tomogram confirmed the hepatodiaphragmatic interposition of the colon and did not show any signs of pulmonary embolism.
Absent liver dullness may be a useful diagnostic clue pointing to hepatodiaphragmatic interposition.
The differential diagnosis must include a number of cardiac and non-cardiac causes of chest pain and breathlessness. The
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- An elderly man with chest pain, shortness of breath, and constipation
- A A Fisher and M W Davis
Postgrad. Med. J. 2003 79: 180.[Extract] [Full Text] [PDF]
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