Unilateral absence of the diaphragm in an asymptomatic adult

An asymptomatic 22-year-old man was evaluated for a persistent left lower lobe infiltrate. Barium enema and upper gastrointestinal series revealed colon and small bowel freely mobile in the left thorax. CT confirmed absence of the left hemidiaphragm. This is the first reported case of total absence of a hemidiaphragm in an adult, and extends the clinical spectrum of diaphragmatic defects where strangulation of hernia contents may occur , the asymptomatic presentation of complete absence of the hemidiaphragm with the unimpeded movement of abdominal contents suggests that no treatment is necessary.