Research: Bochdalek hernia masquerading as pleural effusion in a young adult

Respirol Case Rep

. 2023 Feb 14;11(3):e01104.

 doi: 10.1002/rcr2.1104. eCollection 2023 Mar.

Bochdalek hernia masquerading as pleural effusion in a young adult

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

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Free PMC article


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.

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