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Bochdalek hernia masquerading as a tension pneumothorax
  1. A M Dalton1,
  2. R S Hodgson2,
  3. C Crossley1
  1. 1Emergency Department, Hemel Hempstead Hospital, Hertforshire, UK
  2. 2Department of Gastroenterology, Queen Elizabeth 11 Hospital, Welwyn Garden City, Hertfordshire, UK
  1. Correspondence to:
 Mr A M Dalton
 Emergency Department, Hemel Hempstead Hospital, Hertfordshire HP2 4AD, UK;


A rare case of congenital diaphragmatic defect presenting with clinical signs of an acute tension pneumothorax is described. The clinical findings were eventually attributable to a herniation of abdominal contents into the chest (Bochdalek hernia). Attempted decompression of the chest by needle thoracocentesis and subsequent introduction of a chest drain caused gastric perforation, requiring repair at laparotomy. It is suggested that if needle thoracocentesis does not result in immediate clinical improvement, or if there is abdominal pain, a portable chest radiograph should be performed before tube thoracostomy to exclude Bochdalek hernia. All emergency department staff should be taught to recognise the radiological appearance of a Bochdalek hernia.

  • hernia
  • tension pneumothorax

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  • Funding: none.

  • Conflicts of interest: none declared.