Basheer Ahmed Khan1, Zara Batool2, Unaiza3, Md. Sirajuddin4
CLINICAL DIAGNOSIS
The patient was asymptomatic 7 months back, then developed difficulty in breathing and chest discomfort after food intake, which was associated with loss of appetite and weight. She had history of recurrent URTI and cough. She visited many hospitals where it was misdiagnosed as chronic bronchitis and was treated for the same. She was admitted in our hospital where a diagnosis of Bochdalek hernia was established and the patient was subjected for surgery (repair of diaphragmatic hernia).
On examination, patient was thin, emaciated and dehydrated. There was no pallor, cyanosis, clubbing, lymphadenopathy, oedema and icterus. Family history was not significant. She was conscious and coherent. Vitals were within the normal limits except for her BP being 158/80 mmHg. On systemic examination, there was decreased air entry in the left hemithorax and bowel sounds were present in the left hemithorax. Abdomen was found to be scaphoid shaped. Chest x-ray PA view shows elevated diaphragm on the left side.
CT scan revealed left diaphragmatic hernia with contents as stomach, splenic flexure of colon and omentum. At the level of D7 and D8, the contents are stomach and transversecolon. Atelectatic changes were noted in left lung base. Fibrotic changes were noted in right upper lobe.
