Traumatic Intrapericardial Diaphragmatic Hernia: Diagnostic Challenges and the Role of Multimodal Evaluation

Abstract

Intrapericardial diaphragmatic hernia (IPDH) is a rare condition that commonly occurs after trauma, in which abdominal contents herniate through the central tendon of the diaphragm into the pericardial sac. Diagnosis is frequently delayed due to nonspecific cardiopulmonary symptoms and subtle imaging findings. We performed a narrative review of cases of traumatic IPDH to identify diagnostic challenges and operative strategies and present a case of a 71-year-old woman who developed IPDH following a motor vehicle collision. Initial imaging demonstrated rib, liver, and pelvic fractures without evidence of diaphragmatic injury. After orthopedic surgery, the patient developed chest pain and dyspnea, prompting repeat imaging suggesting IPDH. Robotic-assisted repair revealed a 9-cm anterior diaphragmatic defect containing stomach and omentum, which was repaired with mesh. Postoperatively, the patient developed pericarditis confirmed by cardiac evaluation. This review highlights the diagnostic challenges of IPDH, limitations of imaging, and the importance of multimodal evaluation and timely surgical intervention.