Article Text

Unusual presentation of more common disease/injury
An unusual case of dyspnoea in an elderly man
  1. Palak Jitendrakumar Trivedi1,
  2. James Canavan2,
  3. Cameron Holloway3,
  4. Andrew Slater4,
  5. Simon Travis2
  1. 1
    Oxford Radcliffe Hospitals, Gastroenterology, Horton General Hospital, Oxford Road, Banbury OX16 9AL, UK
  2. 2
    John Radcliffe Hospital, Gastroenterology, Headley Way, Headington, Oxford OX3 9DU, UK
  3. 3
    John Radcliffe Hospital, Cardiovascular Medicine, Headley Way, Headington, Oxford OX3 9DU, UK
  4. 4
    John Radcliffe Hospital, Radiology, Headley Way, Headington, Oxford OX3 9DU, UK
  1. Correspondence to Palak Jitendrakumar Trivedi, palakoid{at}


Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature. Most adolescent and adult cases are diagnosed incidentally during imaging for upper gastrointestinal symptoms. It is unusual for adults to present with respiratory symptoms. We describe the case of a 71-year-old man who presented with features of left ventricular failure due to an exceptionally large, right sided Bochdalek hernia. This is the oldest clinical presentation of a right sided Bochdalek hernia, which uniquely included trans-diaphragmatic herniation of the pancreas.

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  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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