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Non-traumatic trans-diaphragmatic intercostal hernia and cor pulmonale in a patient with poorly controlled obstructive sleep apnoea
  1. Syed Basharath Mehdi1,
  2. Salem Madi2,
  3. Jordan Sudworth3
  1. 1Lancashire Teaching Hospitals, Preston, Lancashire, UK
  2. 2Department of Respiratory, Royal Albert Edward Infirmary, Wigan, UK
  3. 3Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  1. Correspondence to Dr Salem Madi, salem.madi{at}


Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.

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  • Contributors SM is the corresponding author and has overseen the entire writing up of case report. SBM has contributed in selecting and modifying the video and also the context of the article. JS has written the initial draft of the case report. This interesting case along with the video was presented in Trust-wide grandround presentation.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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