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Case report
Postnephrectomy diaphragmatic hernia presenting as progressive dyspnoea
  1. Aqeem Azam and
  2. Kirolos Michael
  1. Respiratory Medicine, Stepping Hill Hospital, Stockport, UK
  1. Correspondence to Dr Aqeem Azam; aqeem.azam89{at}gmail.com

Abstract

The diagnosis of diaphragmatic hernia (DH) in adults is rare and may be due to missed congenital DH or acquired DH from trauma or as a postoperative complication of certain thoracic and abdominal surgeries. We present a case of a patient with well-controlled chronic obstructive pulmonary disease who presented to the hospital with progressive dyspnoea, 6 months after laparoscopic nephrectomy. The patient was initially misdiagnosed and treated for empyema after plain radiographic images were reported as consolidation with gas locules. Multislice CT imaging undertaken before diagnostic thoracocentesis confirmed the presence of a right-sided DH, which was subsequently surgically repaired in the outpatient setting, given her haemodynamic stability. As patients with DH usually present in the emergency setting, requiring urgent inpatient surgical repair, there are currently no guidelines on the method and urgency of management of asymptomatic or mildly symptomatic, stable patients. Furthermore, while plain radiography is the usual first-line imaging modality used, misdiagnosis of DH as pleural effusion or empyema can lead to unnecessary and potentially harmful procedures such as diagnostic thoracocentesis. These risks can potentially be minimised with early utilisation of multislice CT imaging in patients with high clinical suspicion.

  • radiology
  • respiratory medicine
  • gastrointestinal surgery
  • cardiothoracic surgery
  • surgery
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Footnotes

  • Contributors AA made substantial contribution in the design and concept of the case report, producing the draft and revising it critically; obtained signed consent of the patient; contributed in the enhanced literature review of the case report. KM made substantial contribution in revising the case critically and structuring the case to a professional level before submission, acquisition of images and further anonymity of images, contributing in the literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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