A 62-year-old was presented with a 20-year history of breathlessness that worsens when she lay flat or particularly when she swam. She was a smoker but presently she is not. Investigations: Chest radiography showed an elevated left hemidiaphragm and a mediastinal shift to the right. Fluoroscopy revealed a paradoxical movement of the left hemidiaphragm. Spirometry demonstrated a forced vital capacity of 1.28 liters when the patient was supine that increased to 1.44 liters when she stood.
Magnetic resonance imaging of the chest revealed a defect in the left hemidiaphragm (black arrows), with herniation of the stomach and colon (white arrow) into the chest. Source: Moulik, Probal K., and Justine Hadcroft.; New England Journal of Medicine; 347.3 (2002): 193-193. Image Source: NEJM What could be the possible diagnosis? What treatment would you suggest? *This case is from Docplexus Editorial…
