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A 27-year-old man presented with a history of abdominal pain, vomiting and occasional dry cough associated with breathlessness which was worsening on lying down but not relieved by sitting. He had recurrent episodes of similar illness since the past 5 months, and for that he took symptomatic treatment and got relief to some extent. There was no history of wheezing, fever, chest pain, loss of weight or appetite. The patient had a significant history of blunt trauma to the thorax and abdomen 3 years ago by a Pokland machine (a machine used for agriculture purposes), which resulted in bilateral rib fracture that was managed efficiently at that time.
Physical examination, vitals and laboratory investigations revealed no abnormality except for decreased breath sound throughout the left side of the chest. Chest X-ray revealed raised hemidiaphragm and air fluid level on the left side (figure 1). Thoracoabdominal CT showed a breach …