Open AccessAn unusual case of dyspnoea in an elderly man
Author(s) -
Palak Trivedi,
James B. Canavan,
Cameron Holloway,
Andrew Slater,
Simon Travis
Publication year - 2010
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.09.2009.2247
Subject(s) - medicine , bochdalek hernia , pulmonary hypoplasia , congenital diaphragmatic hernia , presentation (obstetrics) , diaphragmatic breathing , diaphragmatic hernia , hernia , surgery , hypoplasia , radiology , pathology , pregnancy , fetus , alternative medicine , biology , genetics
Defective closure of the posterolateral pleuroperitoneal canal during embryogenesis gives rise to a congenital hernia (usually left sided) which was originally described by Bochdalek in 1948. It manifests primarily in children with respiratory symptoms and pulmonary hypoplasia. It is exceptionally rare for this defect to present in adulthood, with just over 50 symptomatic cases being described in the literature. Most adolescent and adult cases are diagnosed incidentally during imaging for upper gastrointestinal symptoms. It is unusual for adults to present with respiratory symptoms. We describe the case of a 71-year-old man who presented with features of left ventricular failure due to an exceptionally large, right sided Bochdalek hernia. This is the oldest clinical presentation of a right sided Bochdalek hernia, which uniquely included trans-diaphragmatic herniation of the pancreas.