Bochdalek hernia

Case contributed by Dr MT Niknejad

Presentation

Workup for cough and breath shortness.

Patient Data

Age: 25 years
Gender: Male
CT

There is herniation of some peritoneal fat through a 40 mm diaphragmatic defect in the posterolateral aspect of right hemidiaphragm.

Case Discussion

Features on CT scan can be compatible with Bochdalek hernia which is a form of congenital diaphragmatic hernia. They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero. Retroperitoneal structures may prolapse through the defect. 
Large hernias typically present in infancy, are usually are said to be most frequently left-sided. In adults, incidentally-discovered posterior diaphragmatic hernias are rare (0.17% of patients having an abdominal CT). Of these, right-sided hernias are more common (68%), and more frequent in females.

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