CHEST Guidelines-A-19-Year-Old-Young-Man-With-Breathlessness-and-Op

A-19-Year-Old-Young-Man-With-Breathlessness-and-Op

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A 19-year-old man experienced non-progressive breathlessness over four years. Previous chest radiography suggested left-sided pleural effusion, leading to empirical TB treatment; however, thoracentesis was not conducted. Upon examination, diminished chest movements and impaired notes on percussion were observed on the left side, with decreased breath sound intensity. A chest radiograph showed left costophrenic angle obliteration consistent with pleural effusion.<br /><br />To explore the condition, a point-of-care ultrasonography (POCUS) was employed. The ultrasound revealed bowel loops with visible peristalsis in the left hemithorax, absence of diaphragm visualization, and bowel loops positioned above the kidney with a displaced spleen. These findings suggested a congenital diaphragmatic hernia (CDH), specifically a Bochdalek hernia. A contrast-enhanced CT scan confirmed the diagnosis, showing a significant posterolateral defect in the left hemidiaphragm, with herniated large bowel loops, some small bowel loops, mesentery, and part of the spleen.<br /><br />CDH in adults is rare, often incidental in CT scans or associated with minor symptoms; it can lead to severe complications like bowel obstruction or volvulus. The condition usually stems from a developmental defect, typically identified in pediatric cases but sometimes presents later due to diaphragm weakness. The POCUS findings were crucial for accurate diagnosis, highlighting the importance of ultrasound guidance to prevent injury during pleural procedures.<br /><br />This case illustrates how POCUS can effectively identify diaphragmatic hernias, allowing prompt diagnosis of conditions mimicking pleural effusion. Awareness of CDH's clinical presentation is essential to prevent complications, reinforcing the importance of POCUS in identifying hernia before performing thoracentesis.

Keywords

congenital diaphragmatic hernia

Bochdalek hernia

point-of-care ultrasonography

pleural effusion

chest radiograph

diaphragm defect

breathlessness

thoracentesis

ultrasound diagnosis

bowel obstruction