Fig. 22

A 31-year-old patient who was on bed rest for lower extremity fracture, now presenting with new-onset chest pain following a severe bout of coughing. Coronal contrast CT demonstrates a large left diaphragmatic hernia, with left kidney, stomach and omentum present within the left thorax. Note decreased enhancement of the left kidney (white arrow) compared with the right kidney on these arterial phase images. The renal artery is normal; the renal vein cannot be evaluated on these arterial-phase images. Intraoperative findings were consistent with these findings demonstrating narrowing of the left renal vein with venous engorgement at the level of the diaphragmatic defect (Movie 5)