Open AccessStrangulated right-sided diaphragmatic hernia presenting and treated as lung empyema: beware of the differential diagnosis
Author(s) -
Sapna Gupta,
Daniel Warrell,
Laurie Smith,
G. L. Williams
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-233440
Subject(s) - medicine , empyema , thorax (insect anatomy) , differential diagnosis , diaphragmatic hernia , emergency department , surgery , diaphragmatic breathing , presentation (obstetrics) , pleural empyema , thoracic cavity , cardiothoracic surgery , chest pain , lung , radiology , hernia , general surgery , alternative medicine , pathology , psychiatry , anatomy
A 78-year-old man with no surgical history or recent trauma presented to the emergency department with sudden onset right-sided chest pain and dyspnoea. He was admitted under the physicians for investigations and was subsequently diagnosed with empyema of the right thorax. After no improvement with intravenous antibiotics, a chest drain was inserted; no pus was drained. He worsened clinically; a repeated CT scan demonstrated an incarcerated loop of small bowel within the right thoracic cavity secondary to a diaphragmatic hernia (DH). The patient had emergency surgery to remove necrotic small bowel and to lavage the thorax. Strangulated DH should be considered as a differential diagnosis where presentation is unusual and empyema does not improve after initial management.