Daily Radiology Case

Explanation

This presentation is most consistent with a congenital diaphragmatic hernia through a posterolateral (Bochdalek) defect, allowing abdominal viscera to herniate into the left hemithorax. The intrathoracic bowel compresses the developing lung, explaining left lung hypoplasia despite an intact bronchial tree, and produces severe mediastinal shift that can mimic “dextrocardia” by shifting the heart rightward rather than reflecting true congenital malposition. Adult presentation can occur when the defect persists uncorrected, with symptoms ranging from mild dyspnea to GI or respiratory complaints depending on the extent of herniation and pulmonary compromise.

Source: Bickle I, Diaphragmatic hernia. Case study, Radiopaedia.org (Accessed on 25 Feb 2026) https://doi.org/10.53347/rID-32541

Hints

• A 41 year-old man presents with chronic mild dyspnea. Vitals are stable; symptoms are longstanding rather than acute.
• Past records note “dextrocardia,” but the patient has no known congenital heart disease and has functioned normally into adulthood.
• Chest imaging shows marked rightward displacement of the mediastinum/cardiac silhouette with severe volume loss of the left hemithorax.
• Within the left thorax, there are multiple air containing tubular structures with an appearance consistent with bowel loops.
• The left lung is markedly hypoplastic and compressed, despite a patent left main bronchus, suggesting a chronic developmental or longstanding compressive process.
• Imaging demonstrates a large posterior diaphragmatic defect with herniation of abdominal contents into the thoracic cavity.