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Case report
Strangulated right-sided diaphragmatic hernia presenting and treated as lung empyema: beware of the differential diagnosis
  1. Sapna Gupta,
  2. Daniel Warrell,
  3. Laurie Smith and
  4. Gethin Llewellyn Williams
  1. Royal Gwent Hospital, Newport, UK
  1. Correspondence to Sapna Gupta; sapnagupta{at}


A 78-year-old man with no surgical history or recent trauma presented to the emergency department with sudden onset right-sided chest pain and dyspnoea. He was admitted under the physicians for investigations and was subsequently diagnosed with empyema of the right thorax. After no improvement with intravenous antibiotics, a chest drain was inserted; no pus was drained. He worsened clinically; a repeated CT scan demonstrated an incarcerated loop of small bowel within the right thoracic cavity secondary to a diaphragmatic hernia (DH). The patient had emergency surgery to remove necrotic small bowel and to lavage the thorax. Strangulated DH should be considered as a differential diagnosis where presentation is unusual and empyema does not improve after initial management.

  • empyema
  • surgery
  • gastrointestinal surgery
  • general surgery
  • radiology

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  • Contributors SG: writing case report, planning, conduct, design. DW: acquisition of data, editing. LS: acquisition of data, design. GLW: planning, conception, editing.

  • 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.