A diaphragmatic hernia (DH) is a defect in the diaphragm allowing abdominal contents to protrude into the thoracic cavity. It is usually diagnosed in neonates with severe respiratory distress. In 5–25% of cases of congenital DH (CDH), it may present in adults with non-specific signs. This may be due to an increase in pleuroperitoneal pressure gradient across embryological fusion sites due to trauma, pregnancy, etc. We report a case of a 60-year-old woman presenting with chief complaints of epigastric pain and episodic respiratory difficulty with a history of abdominal blunt trauma. Chest X-ray, high-resolution computed tomography (CT)-thorax and CT-abdomen findings were consistent with the diagnosis of post-traumatic presentation of CDH in adulthood. The patient underwent successful surgical repair of the DH with an uneventful post-operative course. Thus, high clinical suspicion augmented by appropriate imaging is the key to a correct diagnosis and management of such atypical cases.
Basu et al. (Wed,) studied this question.