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Case Report
Massive pleural effusion post-emergency cesarean in undiagnosed congenital diaphragmatic hernia
1 Emergency Physician, Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
2 Medical Officer, Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
3 Consultant Emergency Physician, Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Address correspondence to:
Nurul Liana Roslan
Emergency Physician, Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur,
Malaysia
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Article ID: 101378Z01NR2023
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Roslan NL, Nikkie L, Wahab MA. Massive pleural effusion post-emergency cesarean in undiagnosed congenital diaphragmatic hernia. Int J Case Rep Images 2023;14(1):33–38.ABSTRACT
Introduction: Bochdalek’s hernia is a congenital diaphragmatic hernia (CDH) resulting from inadequate closure of the membrane over the left side of the hemidiaphragm. Patients will start to develop symptoms upon displacement of abdominal contents into the thoracic cavity. This case report highlights the radiological modality findings that can be used in diagnosing a late-presentation CDH in adults.
Case Report: A 35-year-old postpartum woman developed shortness of breath, left-sided chest pain, episodes of vomiting and epigastric tenderness within 24 hours post-emergency cesarean section. An initial diagnosis of left tension hydrothorax was made based on the clinical and radiological findings. Left diagnostic and therapeutic thoracocentesis using landmark technique was performed and brownish fluid was obtained upon aspiration. Post-procedural chest X-ray (CXR) reported cystic-like features over the left hemithorax. Therefore, computed tomography (CT) thorax was proceeded and confirmed the left diaphragmatic hernia with a mediastinal shift to the right. However, the patient’s condition worsened and required emergency open thoracotomy with left diaphragmatic hernia repair. Intraoperative findings showed left Bochdalek’s hernia complicated by multiple visceral organ perforations secondary to previous thoracocentesis. The patient was discharged well after a few weeks of hospital stays.
Conclusion: The diagnosis of late-presentation Bochdalek’s diaphragmatic hernia remained challenging and can be easily missed. Therefore, a comprehensive evaluation is required prior to performing an invasive diagnostic procedure. Chest X-ray and ultrasound are useful diagnostic aid in the absence of CT thorax and magnetic resonance imaging (MRI) modalities.
Keywords: Bochdalek’s hernia, CDH, Diaphragmatic hernia, Pleural effusion
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Acknowledgments
The authors would like to thank the Director General of Health Malaysia for the permission to publish the paper, Dr. Adelin Rachel Doss for her assistance in writing this paper.
Author ContributionsNurul Liana Roslan - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lim Nikkie - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mahathar Abd. Wahab - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Nurul Liana Roslan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
