. The American journal of roentgenology, radium therapy and nuclear medicine . the base. A routine .r-ray examination of the chest(Fig. i) disclosed it as normal for a manof his age, with the exception of the shadowin the lower left thorax. This shadow at first was thought to bea pneumothorax, or possibly a diaphragmatichernia. To make the differential diagnosisthe patient was given a barium meal; thetwo-meal method was employed. FLUOROSCOPIC EXAMINATION. The patient is tall and slender; the inter-costal angle is somewhat less than a rightangle; he approaches the asthenic type. Standing Positi
. The American journal of roentgenology, radium therapy and nuclear medicine . the base. A routine .r-ray examination of the chest(Fig. i) disclosed it as normal for a manof his age, with the exception of the shadowin the lower left thorax. This shadow at first was thought to bea pneumothorax, or possibly a diaphragmatichernia. To make the differential diagnosisthe patient was given a barium meal; thetwo-meal method was employed. FLUOROSCOPIC EXAMINATION. The patient is tall and slender; the inter-costal angle is somewhat less than a rightangle; he approaches the asthenic type. Standing Position.—The upper thorax isnegative; the lower right thorax is also neg-ative. Occupying the lower left thorax thereis an area of high light which extends upinto the thorax from below as high as thethird interspace in front and ninth rib be-hind. This area is bounded by a definitethin line extending from the spine almostto the lateral wall of the thorax. It isroughly pear-shaped in outline. On inspir-ation the right dome of the diaphragmmoves down readilv; the left cannot be. Fig. 2. made out with certainty. On the left side,on inspiration, there is definite movementof the splenic flexure upward, but the areaof high light changes very little. It tiltssomewhat and slightly flattens. This is sug-gestive of a paradoxical respiratory i)he-nomena. The shadow of the heart andlower bronchovascular tree can be seenthrough this area. In the lateral positionthis area is somewhat posterior to the heart. The cecum, transversus and splenic flex-ure, except for high position, are splenic flexure lies very close to the areabut is below it. The esophageal function is normal. Thebarium enters the stomach just below themedial margin of this area of high light. Itsplashes upon its inner surface and drains Diaphragmatic Hernia Without Severe Symptoms 249 out immediately into the middle portion ofthe stomach. There is a definite constric-tion just below the fundus (as this area isnow ident
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