Absent Lung Slide but No Pneumothorax: A Case of Spontaneous Diaphragmatic Hernia Presenting with Dyspnea

Abstract

Spontaneous diaphragmatic rupture is one of the rarest thoracoabdominal emergencies. The diagnosis may be delayed if a patient presents with respiratory symptoms without any history of trauma. In this report, we present a case who was admitted to the emergency department with shortness of breath, nausea, vomiting lasting for 3 h, and was diagnosed initially with pneumothorax based on chest X-ray and ultrasonography thorax findings. An intercostal drain was placed in the emergency ward. This was later diagnosed to have spontaneous diaphragmatic rupture. The patient was operated upon, and the defect was repaired. Diaphragmatic rupture should be considered along with other possible diagnoses, especially in the presence of suspicious appearances on the chest radiography in a patient with respiratory and/or gastrointestinal symptoms. The utility of bedside ultrasound in the diagnosis of spontaneous diaphragmatic hernia is yet unproven. The only treatment is surgical along with supportive care.