Objective To explore the signs of diaphragmatic hernia chest X - ray and the application value of barium meal, in order to further deepen the understanding of the signs of diaphragmatic hernia chest X - ray and the performance of barium meal, and also to analyze the causes of the misdiagnosed cases of chest X - ray diagnosis. Methods Retrospective analysis was conducted for the diaphragmatic hernia chest X - ray signs and barium meal performance in 22 patients after a barium meal and partial surgery confirmation. Results Diaphragmatic hernia signs were as follows: ①diaphragmatic surface outline was not clear and false diaphragmatic surface increased; ②there was diaphragm shadow or cystic mass shadow ( with gas or liquid square ), with the diaphragmatic muscle not easy to separate, and wide atmosphere liquid surface in chest; there was cystic shadow in cardio - diaphragmatic area in the lower lung field; there was mass shadow in the substernal anterior rib septal area; there was a honeycomb of bright shadow in unilateral lung field; ③ the variability of chest shadow: the shape, density and content of the shadow could be changed in different time and different position; ④ the adjacent viscera abnormality: there was a shift of mediastinum to normal side and an upward shift of intra - abdominal organs; ⑤barium was found to enter into shadows of chest in the barium meal. Conclusion Pure chest X - ray signs can be highly suggestive of diaphragmatic hernia diagnosis; barium meal has important diagnostic value in specific diaphragmatic hernia diagnosis.%目的 探讨膈疝的胸部X线征象及钡餐造影应用价值,对胸部X线检查出现误诊漏诊病例进行原因分析.方法 回顾分析22例患者经钡餐造影和部分手术证实为膈疝的胸部X线征象及钡餐造影表现.结果 膈疝具有下列征象:①膈面异常:膈面轮廓不清,假膈面升高;②胸腔纵隔心影重叠区异常阴影:膈上囊状影或团块影(可含气、液平面),且与膈肌不易分开;胸腔宽大气液面;胸部侧位见心后食管走形区大小不一的囊状影或肿块影;下肺野心膈角区囊状影;胸骨后前肋膈角区团块影;单侧肺野蜂窝状透亮影;③胸腔阴影形态的可变性:不同时间、不同体位阴影的形态、密度及内容物可发生变化;④临近脏器异常:纵隔向健侧移位,腹腔脏器上移位;⑤钡餐造影发现钡剂进入胸腔阴影内.结论 单纯胸部X线征象可以高度提示膈疝的诊断,钡餐造影对明确膈疝的诊断有重要诊断价值.
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