Related Experiment Video
Updated: Aug 9, 2025

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Bochdalek hernia masquerading as pleural effusion in a young adult
Charles Wong1, Chin Tou Lam2, Loretta Yin Chun Yam1
1Department of Medicine Pamela Youde Nethersole Eastern Hospital Hong Kong Hong Kong.
Abstract:
Bochdalek hernia (BH) is a congenital diaphragmatic hernia which rarely presents in adulthood. We report on a 25-year-old man admitted with 3-year recurrent and self-limiting abdominal pain and vomiting. Chest radiograph showed left pleural opacity which shifted position in the decubitus film suggesting pleural effusion. Before attempting drainage, point-of-care (POC) thoracic ultrasound (TUS) demonstrated features of intrathoracic gastrointestinal content above the left hemi-diaphragm. Computed tomography of the thorax confirmed a large left BH. Acute recurrent symptoms 3 months post-discharge was associated with BH enlargement and early bowel ischemia, which was successfully managed by emergency surgery. This case illustrates the importance of pre-procedural imaging with POC-TUS before pleural procedures in all cases of suspected or apparent pleural effusion, and of prompt surgical treatment of symptomatic BH despite clinical stabilization.
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