Bochdalek hernia masquerading as a tension pneumothorax.
A rare case of congenital diaphragmatic defect presenting with clinical signs of an acute tension pneumothorax is described. The clinical findings were eventually attributable to a herniation of abdominal contents into the chest (Bochdalek hernia). Attempted decompression of the chest by needle thoracocentesis and subsequent introduction of a chest drain caused gastric perforation, requiring repair at laparotomy. It is suggested that if needle thoracocentesis does not result in immediate clinical improvement, or if there is abdominal pain, a portable chest radiograph should be performed before tube thoracostomy to exclude Bochdalek hernia. All emergency department staff should be taught to recognise the radiological appearance of a Bochdalek hernia.
Dalton
A M
AM
Emergency Department, Hemel Hempstead Hospital, Hertforshire, UK. daltonmark@yahoo.com <daltonmark@yahoo.com>
Hodgson
R S
RS
Crossley
C
C
D000328:Adult; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis* / Q000601:surgery; D011859:Radiography; D017211:Treatment Failure