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Updated: Dec 21, 2025

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Published on: August 9, 2024
An 82-year-old female with chest pain radiating to the back and flank
Nima Nassiri1, Marissa Maas1, Kian Asanad1
1Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
Abstract:
An 82 year-old female presents with severe, sharp right-sided chest, shoulder and flank pain, worse with deep inspiration. Cardiac workup is negative for myocardial ischemia or aortic dissection. Computed tomography demonstrates a right posterior diaphragmatic (Bochdalek) hernia, involving the right extra-renal pelvis and proximal ureter, with an associated delayed nephrogram and mild hydronephrosis. There is no obstructing nephrolithiasis. The patient is taken to the operating room and right-sided double-J ureteral stent is placed (Fig. 1), with immediate resolution of pain. Diaphragmatic hernia repair in coordination with urology and general surgery is scheduled.
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