Case reports

A 27-year-old man was admitted to the medical casualty with severe left sided chest pain and repeated vomiting. On admission, he was acutely ill and restless. Radial pulse was of low volume and fast at100/min while blood pressure was 80/60 mmHg. The trachea had shifted to the right side and air entry to the left chest was markedly reduced. The opacity seen in the chest radiograph was initially considered to be a large left sided pleural effusion. A chest drain was inserted into the left pleural cavity, but there was only a little improvement of the patient’s clinical picture (Figure 1). The patient was reviewed and the diagnosis of obstructed left diaphragmatic hernia was made. Abdominal radiographs were not of much help.