Yi-Suk Kim; In Sun Lee; Go-Un Jung; Myeung Ju Kim; Chang Seok Oh; Dong Su Yoo; Won-Joon Lee; Eunju Lee; Soon Chul Cha; Dong Hoon Shin

“ Munizaga et al. (1978) concluded that an Atacamena Indian mummy dating to the 3rd century CE might have died of complications from jejunum strangulation caused by herniation into the thoracic cavity. This remains the sole Bochdalek CDH case ever reported on the basis of an archaeological investigation [2] .
Over the past several years, 16th to 19th century Korean mummies have come to be recognized as excellent subjects for studies on pre-modern Korean peoples and societies. ”

“ Actually, the right lung was compressed by the herniation; and the heart was shifted more to the left side of the thoracic cavity. As in other adult CDH cases already reported, it was speculated that this individual might have experienced some difficulties such as shortness of breath, abdominal pain, chest pain, nausea, or vomiting during his lifetime [6] , [30] .
Most cases of Bochdalek CDH occur in infants or neonates with life-threatening complications, adult cases being relative rarities and asymptomatic [7] , [8] – [9] , [31] . ”

“ Some adult cases clearly show how well the clinical signs of CDH can be masked as individuals grow into adulthood. One such example is a 50-year-old female patient who complained of mild dyspnea. In this patient, clinicians found very few signs and symptoms suggestive of adult CDH. By CT diagnostics, however, a remarkable displacement of abdominal organs into the thoracic cavity could be detected. Additionally, serious atelectasis was also found in her left lung, while most of the left thoracic cavity was filled by displaced abdominal organs. ”

“ Images were reviewed with lung, bone and soft tissue settings on multi-planar format (axial, sagittal, and coronal images) on a work station (Advantage Windows Workstation 4.3, GE healthcare) . In total, 2465 axial scans were utilized in this study.
For the purposes of comparisons with the current CDH case, we employed CT images of another Joseon-era Korean mummy. He was found in a Joseon tomb on November of 2007 (nick-named the Gangneung mummy) . According to historical documentation, a male was born in 1561 and died in 1622 at the age of 61. ”

“ Mainly intestine (Int) is visible. (J) Large liver (LV) could be seen at the same level of Gangneung mummy. (K) and (L) LV1 level. Intestine or other mummified abdominal organs fills the cavity in both CT images. The reformatted sagittal and coronal images also showed herniated organs. There was a large diaphragmatic defect, through which organs were herniated into the right thoracic cavity (Figure 3) . We speculated that the herniated organs were the liver and bowel.
Coronal CT images of the current Andong mummy with Congenital Diaphragmatic Hernia. ”

“ Examination of Andong mummy. (A) Removal of clothing. (B) and (C) Very well preserved human and cultural remains. (B) is hand; (C) is straw shoes. (D) The mummy examined in this study. Prior to the commencement of our gross examination, textile specialists removed the mummy's shrouds. We then performed anthropometric measurements on the mummy, following the Standards for Data Collection from Human Skeletal Remains [16] . ”

“ Bell-shape incision was on mummy. Anterior body wall was turned over back. Pleura and peritoneum are exposed. (B) Dissection of left lung. No herniated organs were found in left thoracic cavity. RL, right lung; LL, left lung; Pe, pericardium. (TIF)
File:Pone.0099779.s001.tifClick here for additional data file. Data S2 Age estimation based on Lamendin's method (1992) . (DOC) (data file pone.0099779.s002.doc)
Data S3 Anthropometric data. (DOC) (data file pone.0099779.s003.doc)
Data S4 (A) Left-sided lung detached from pericardium (Pe) . Left lung (LL) becomes very thin. ”

“ Williams, L & Lawson, B (2012) , “Scenes from the past: Multidetector CT of Egyptian Mummies of the Redpath Museum”, Radiographics 32: 1235–1250, 22787004 WadeAWGarvinGJHurnanenHJWilliamsLLawsonBet al, pmid:22787004 ↑ Rout, S ”