Idiopathic left-sided diaphragmatic hernia: a rare clinical image

¹Department of Cardio-Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Sawangi Meghe, Wardha, Maharashtra, India

^&Corresponding author
Rashmi Ramesh Walke, Department of Cardio-Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences (DU), Sawangi Meghe, Wardha, Maharashtra, India

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Idiopathic diaphragmatic hernia, which occurs without a traumatic etiology, is a very unusual condition with a wide spectrum of medical symptoms. Cough, chest pain, dyspnea, upper abdomen pain, bowel bladder problems, and vomitus are some of the common respiratory and gastrointestinal symptoms. To minimize life-threatening morbidity and fatality, surgery is required. This is a case of idiopathic left-sided diaphragmatic hernia which is an extremely rare condition. A 60-year-old male with no history of trauma reported to have been experiencing pain in the left upper abdomen along- with breathing difficulties for the past 15 days. The pain was insidious in onset and progressive. On physical examination, chest expansion revealed differences of 2 cm, 2 cm, and 1 cm each along-with tenderness in the epigastric area. On auscultation, air entry was reduced bilaterally over lung fields. On investigation computed tomography (CT) impression of the abdomen and pelvis showed: 1) Large defect noted in left crus of the diaphragm with herniation of stomach to the left thoracic cavity. 2) There is a shift of mediastinum towards the right side. 3) Herniation of abdominal contents into the thoracic cavity. 4) Mild left-sided-pleural effusion with the consolidation of the left basal lung.

Figure 1: CT image of depicting herniation of abdominal contents into the thoracic cavity and shift of mediastinum towards right side