Respirol Case Rep

. 2023 Feb 14;11(3):e01104.

 doi: 10.1002/rcr2.1104. eCollection 2023 Mar. https://pubmed.ncbi.nlm.nih.gov/36818459/

Bochdalek hernia masquerading as pleural effusion in a young adult

Charles Wong ¹, Chin Tou Lam ², Loretta Yin Chun Yam ¹

Affiliations expand

• PMID: 36818459
• PMCID: PMC9928942
• DOI: 10.1002/rcr2.1104

Free PMC article

Abstract

Bochdalek hernia (BH) is a congenital diaphragmatic hernia which rarely presents in adulthood. We report on a 25-year-old man admitted with 3-year recurrent and self-limiting abdominal pain and vomiting. Chest radiograph showed left pleural opacity which shifted position in the decubitus film suggesting pleural effusion. Before attempting drainage, point-of-care (POC) thoracic ultrasound (TUS) demonstrated features of intrathoracic gastrointestinal content above the left hemi-diaphragm. Computed tomography of the thorax confirmed a large left BH. Acute recurrent symptoms 3 months post-discharge was associated with BH enlargement and early bowel ischemia, which was successfully managed by emergency surgery. This case illustrates the importance of pre-procedural imaging with POC-TUS before pleural procedures in all cases of suspected or apparent pleural effusion, and of prompt surgical treatment of symptomatic BH despite clinical stabilization.

Keywords: Bochdalek hernia; CXR; pleural effusion; thoracic ultrasound.

© 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.