Bochdalek Hernia with Liver Content Simulating a Pulmonary Neoplasia: A Case Report and Literature Review
Kabura Sylvestre *
Service of General Surgery Aile I, University Hospital Center Ibn Rochd, Casablanca, Morocco.
Abdellah Fatene
Service of Thoracic Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco and University of Hassan II Casablanca, Morocco.
Najat Idelhaj
Service of Thoracic Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco and University of Hassan II Casablanca, Morocco.
Souheil Boubia
Service of Thoracic Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco and University of Hassan II Casablanca, Morocco.
Mohamed Ridai
Service of Thoracic Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco and University of Hassan II Casablanca, Morocco.
Elabbassi Taoufik
Service of General Surgery Aile I, University Hospital Center Ibn Rochd, Casablanca, Morocco,University of Hassan II Casablanca, Morocco and Department of General Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco.
Rachid Lefriyekh
Service of General Surgery Aile I, University Hospital Center Ibn Rochd, Casablanca, Morocco,University of Hassan II Casablanca, Morocco and Department of General Surgery, University Hospital Center Ibn Rochd, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Bochdalek hernia (BH) is a congenital diaphragmatic hernia through the posterolateral diaphragmatic defect. It is rare in adult. Only 5% are detected in adulthood and the patients may present chronic symptoms, such as chronic dyspnoea, chest pain and pleural effusion. The diagnosis of BH is made by imaging assessment and the best radiological investigation is CT scan which has a sensitivity of 78% for left-sided hernia and 50% for the right-sided hernia. The differential diagnosis of BH is: neoplastic disease, pulmonary sequestration, foreign material aspiration, tension pneumothorax, pneumonia, pleuritis or pulmonary tuberculosis. The identification of a solitary lesion in posterolateral region, especially if it is of fat attenuation, should also prompt a search for an associated diaphragmatic defect in order to establish the diagnosis of a Bochdalek hernia. Management of a BH includes reducing the abdominal contents and repairing the defect, through laparotomy or thoracotomy or combined method whether laparoscopy or thoracoscopy regardless of the presence of symptoms. We here report a patient in whom this hernia mimics pulmonary neoplasia, thereby illustrate this disorder, together with brief literature reviews.
Keywords: Bochdalek hernia, diaphragm hernia, diagnosis, thoracoscopy