An unusual case of dyspnoea in an elderly man

Area of Science:

• Medical Case Reports
• Congenital Abnormalities
• Diaphragmatic Hernias

Background:

• Bochdalek hernia results from defective embryogenesis of the pleuroperitoneal canal, typically presenting in children with respiratory distress.
• Adult presentation of Bochdalek hernia is rare, often asymptomatic or incidentally discovered during imaging for unrelated gastrointestinal complaints.
• Respiratory symptoms are unusual in adult Bochdalek hernia cases.

Purpose of the Study:

• To report the oldest known clinical presentation of a right-sided Bochdalek hernia.
• To describe a unique case of adult Bochdalek hernia causing cardiac compromise.
• To highlight the unusual trans-diaphragmatic herniation of the pancreas in this adult Bochdalek hernia.

Main Methods:

• Case study of a 71-year-old male patient.
• Clinical presentation analysis.
• Review of existing literature on adult Bochdalek hernias.

Main Results:

• The patient presented with symptoms of left ventricular failure.
• An exceptionally large, right-sided Bochdalek hernia was identified as the cause.
• The hernia uniquely contained herniated pancreatic tissue trans-diaphragmatically.
• This represents the oldest reported adult case of a right-sided Bochdalek hernia.

Conclusions:

• Bochdalek hernias can present atypically in advanced age with severe cardiopulmonary compromise.
• Right-sided Bochdalek hernias are exceptionally rare and can involve unusual herniated organs like the pancreas.
• This case expands the understanding of late-onset Bochdalek hernia presentations and their potential severity.