1Department of Internal Medicine Saiseikai Nara Hospital, 2Department of Radiology Saiseikai Nara Hospital, 3Department of Radiology, Nara Prefectural Gojo Hospital, 4Department of Oncoradiology, Nara Medical University, 5The second Department of Internal Medicine, Nara Medical University
Rupture of the diaphragm, Ultrasonography, Lung cancer, Adrenal metastasis
The patient, a 57-year-old male diagnosed with lung cancer at another hospital, consulted our hospital complaining of abdominal pain. Diagnostic imaging revealed an adrenal metastasis, 8 cm in size. To treat this metastasis, TAE was administered three times. Twenty days after the third TAE treatment, the patient complained of sudden epigastric pain and hematemesis. A chest radiograph revealed a large cavity in the left lung field and ultrasonography indicated a large quantity of fluid in the left pleural cavity. Real-time observation of the chest region by ultrasonography revealed air bubbles arising steadily from the lower portions of the liquid in the pleural cavity. This findings suggested that the pleural cavity was in anatomical communication with the digestive tract. Gastric fluoroscopy and CT scanning showed prolapse of the stomach into the pleural cavity. The prolapse was thought to be due to rupture of the diaphragm.