An 82-year-old female with chest pain radiating to the back and flank

An 82 year-old female presents with severe, sharp right-sided chest, shoulder and flank pain, worse with deep inspiration. Cardiac workup is negative for myocardial ischemia or aortic dissection. Computed tomography demonstrates a right posterior diaphragmatic (Bochdalek) hernia, involving the right extra-renal pelvis and proximal ureter, with an associated delayed nephrogram and mild hydronephrosis. There is no obstructing nephrolithiasis. The patient is taken to the operating room and right-sided double-J ureteral stent is placed (Fig. 1), with immediate resolution of pain. Diaphragmatic hernia repair in coordination with urology and general surgery is scheduled.