Diaphragmatico-pericardial tear with intrapericardial herniation of the transverse colon.

Herniation of the abdominal contents into the chest through a diaphragmatic hernia or through a traumatic diaphragmatic tear is not uncommon. The case to be reported here is of special interest because of the rarity of the type of herniation observed, the long delay which preceded the diagnosis, and the unusual fashion in which the clinical and radiological picture simulated cardiac disease. Case Report A 45-year-old white male physician had felt well until May 1946, when he experienced tachycardia, fatigue, and slight dyspnea following moderate exertion. He was overweight and attributed the symptoms to obesity. In 1947 he had an episode of chest pain during exertion in cold weather, which he interpreted as an anginal attack. In 1948, frontal headaches developed. At this time, an enlargement of the cardiac contour was demonstrated roentgenologically, and the patient's past history was obtained. On June 20, 1943, while on service with the Armed Forces in North Africa, he had been in a jeep accident which c...