Presentation
Presented to the emergency department with sudden dyspnea, accompanied with nausea and vomiting. Associated cough and general malaise, but not febrile. On physical examination only a hyperemic pharynx is seen, with decreased cardiac sounds in the left hemithorax on auscultation.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
In the initial chest radiograph, a radiolucent cystic large lesion is present, which occupies most of the left chest. It has a thin wall and an air-fluid level, it displaces the mediastinum, the trachea and the right lung compensates with overdistention.
24 hours after the radiograph, CT of the neck and chest is performed
There is air occupying the left hemithorax within a thin-walled structure, with liquid contents forming an air-fluid level, displacing the upper lung lobe apically, and compressing the left pulmonary hilum, amputating the bronchus. It is not possible to identify the stomach, and neither loculation or an incomplete septum in the collection is identified.
An intercostal catheter is placed due to pneumatocele being the probable diagnosis, obtaining only serous and milky material without detecting the presence of pus. A partial reduction of radiolucent lesion size and the presence of pneumothorax are observed in the radiograph.
Subsequently, not observing the gastric chamber and finding esophageal dilation, it was decided to administer water soluble contrast medium, achieving opacification of the esophagus into the distal third, without showing passage to the stomach.
Chest and abdomen after reduction of the hernia.
Case Discussion
The diagnosis of probable Bochdalek hernia was established, so a surgical exploration was performed, finding a congenital diaphragmatic hernia with intra-thoracic stomach and partial gastric volvulus.
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