X-ray cross-section images of a centuries-old mummy reveal that the middle-aged man suffered from a type of hernia where the abdominal contents protruded into the chest cavity. This condition, called congenital diaphragmatic hernia (CDH), is a birth defect that usually comes with life-threatening complications in babies. And though he survived, the tools to diagnose his condition weren’t invented until hundreds of years later.
A team of researchers led by Dong Hoon Shin from Seoul National University College of Medicine examined a mummy that was discovered lying face up in a coffin last year at the Joseon tomb in a southeastern Korean city called Andong. Carbon dating estimated its age to be about 230 years old, having lived around 1783. The team determined the mummy to be a male who died at the age of 45. He was 1.6 meters (5 feet, 3 inches) tall, and a topknot on his head suggests he was married.
Using x-rays that create cross-section pictures — or computed tomography (CT) imaging — the team found that the abdominal contents had protruded into the right chest cavity through a defect in the diaphragm, the thin sheet of muscle that stretches across the bottom of our rib cage.
They performed a total of 2,465 scans. Here are some CT images showing the herniated organs.
When they conducted an autopsy on the mummy, their initial diagnosis was confirmed. The herniated contents include the right lobe of the liver, parts of the stomach and the membrane that hangs down from it, and the right bend of the colon.
Taking these results together, the researchers diagnosed this case as Bochdalek-type CDH — or protrusion through the back side of the diaphragm. To make sure it was a CDH case, and not just an artifact of preservation, they compared the Andong Mummy to another Joseon-era mummy who showed no evidence of CDH. This is the first report of a CT-assisted diagnosis of a pre-modern hernia case. The work was published in PLoS ONE this week.
CDH typically results in pulmonary problems in newborns and infants, and it can happen in one out of 3,600 babies. Most cases occur with life-threatening complications, so finding a middle-aged case from so long ago is quite unusual. The researchers speculate that this individual might have experienced shortness of breath, abdominal and chest pains, nausea, or vomiting during his lifetime. Despite that, CDH itself was probably not the main cause of death since the team found no evidence of perforation or strangulation of the herniated organs. They suspect the functional defects caused by CDH might have been largely compensated for as he grew older.
Images: 2014 Kim et al. PLoS ONE