Case presentation
A 72 years old lady presented to the outpatient department with a
history of on and off epigastric discomfort, burping, and water brash
for one year. She also complained of occasional dyspnoea after food
intake, not severe enough to restrict daily activities. She was being
managed in the line of acid peptic disorder. She gave no history of
cough, orthopnoea, tachypnoea, chest pain. She denied any history of
previous surgery or trauma. However, she had a past history of
Tuberculosis infection 25 years back, for which she had received
antitubercular medications. She does not consume alcohol but has been
smoking for 25 years with a pack-year of 6.25.
Her general physical examination was normal with stable vital signs. On
chest examination, there was decreased movement on the right side
inframammary area. Tactile vocal fremitus and breath sounds were also
reduced on the right side. Respiratory rate was normal with no signs of
respiratory distress.
Routine investigations showed no abnormalities. X-ray of the chest
revealed a focal upward bulge in the contour of the right hemidiaphragm
at the medial aspect, with no herniation of abdominal content into the
right hemithorax. (Figure 1) Also, a lobulated radiopaque lesion was
noted in the medial aspect of the lower lung zone, the caudal aspect of
which was extending below the right diaphragmatic dome. The lesion was
likely a calcified granulomatous lesion. Plain CT of the chest
(Mediastinal Window) in coronal (Figure 2) and sagittal planes(Figure 3)
showed focal thinning of the right hemidiaphragm in the anterior aspect
without obvious diaphragmatic defect. The adjacent right lobe of the
liver appeared to bulge into the thinned portion. Based on the
radiological findings, diagnosis of eventration of right hemidiaphragm
was made.
The case was thoroughly assessed and evaluated by a team of experts at
our center and with no immediate need for surgical intervention; she was
managed conservatively and reviewed on regular follow-up visits. A
physiotherapy consultation was done. Counseling for smoking cessation
was also done.