Diaphragmatic Hernia Masquerading as Pleural Effusion
A 40-year-old man slipped and fell against the edge of his bath tub. He presented to a clinic where he was treated with analgesics and discharged after an apparently normal chest X-ray. After a year, he presented to the internal medicine department of another hospital with chest pain and shortness of breath. There was no history of cough or fever. On examination, he was afebrile with normal vital signs and oxygen saturation. Examination of the chest revealed dullness in the left infra-mammary and infra-scapular regions with markedly diminished breath sounds. X-ray chest was suggestive of left pleural effusion []. Ultrasound of the chest was reported as thick effusion and marked for thoracocentesis.\nA needle aspiration was attempted, but failed. Subsequently, a computerized tomography (CT) scan revealed a 2.5 cm defect in the anterior aspect of the left hemidiaphragm with herniation of omentum into the left chest []. The patient was then referred to our center for further management.\nAt thoracotomy, the omentum was found densely adherent to the diaphragm, left lung, pericardium, and chest wall []. There was no herniation of stomach, colon, or spleen. The adhesions were carefully released. An omentectomy [, inset] was done as it was not possible to reduce the entire herniated omentum into the abdomen. The defect in the diaphragm [] was closed with interrupted horizontal mattress sutures of 2-0 ethibond. Postoperative recovery was uneventful. He was asymptomatic at 1 year follow-up.