This history is designed to mislead as no pathology is demonstrated here. Interposition of colon between the liver and the diaphragm (chilaiditis syndrome) can simulate pneumoperitoneum. Haustration of the bowel can usually be identified but if there is doubt, then a left lateral decubitus film should be performed.
In diaphragmatic eventration the normal muscular part of a hemidiaphragm is deficient and replaced by connective tissue. There is normally a dome-like bulging of the anterior aspect of the diaphragm. It is common in the elderly when the bulging may be focal. A lateral projection will show the posterior costophrenic recess to be in the normal position and if screened under fluoroscopy some diaphragmatic movement can be identified.
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