Fig. 2

Diaphragmatic perforation and trans-diaphragmatic herniation. a Chest radiograph at admission shows mild blunting of the right costophrenic angle (black arrow). b Axial CT scan at admission reveals a mushroom-shaped diaphragmatic contour of the herniated omental fat (white arrows). c Follow-up axial CT scan after 2 months reveals a large pleural effusion and massive intrathoracic herniation of omental fat without organ entrapment. d Reformatted sagittal CT image shows direct discontinuity of the right hemidiaphragm (white arrowheads)