This case demonstrates a large right diaphragmatic hernia which was likely acquired given previous chest x-rays were normal. The patient had a history of poorly controlled asthma and raised intra-abdominal pressure from persistent cough may have provoked the diaphragmatic rupture.

The patient proceeded to have an emergency bronchoscopy, laparotomy and repair of the  right diaphragmatic hernia.

Her post-operative chest x-ray reveals restoration of the normal anatomical position of the intra-abdominal organs and right hemidiaphragam.