Bochdalek hernia masquerading as pleural effusion in a young adult

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.