Bochdalek Hernia with Liver Content Simulating a Pulmonary Neoplasia: A Case Report and Literature Review

Abstract

Bochdalek hernia (BH) is a congenital diaphragmatic hernia through the posterolateral diaphragmatic defect. It is rare in adult. Only 5% are detected in adulthood and the patients may present chronic symptoms, such as chronic dyspnoea, chest pain and pleural effusion. The diagnosis of BH is made by imaging assessment and the best radiological investigation is CT scan which has a sensitivity of 78% for left-sided hernia and 50% for the right-sided hernia. The differential diagnosis of BH is: neoplastic disease, pulmonary sequestration, foreign material aspiration, tension pneumothorax, pneumonia, pleuritis or pul­monary tuberculosis. The identification of a solitary lesion in posterolateral region, especially if it is of fat attenuation, should also prompt a search for an associated diaphragmatic defect in order to establish the diagnosis of a Bochdalek hernia. Management of a BH includes reducing the abdominal contents and repairing the defect, through laparotomy or thoracotomy or combined method whether laparoscopy or thoracoscopy regardless of the presence of symptoms. We here report a patient in whom this hernia mimics pulmonary neoplasia, thereby illustrate this disorder, together with brief literature reviews.