Abstract

A 25-year-old female presented with acute left-sided chest pain for one hour. She reported a history of dull chest pain for three days, which had worsened in the past hour. On examination, she was tachypneic, hypoxic, and had decreased air entry on the left side of chest. Point of care ultrasonography (POCUS) suggested absent lung sliding. Based on physical examination and POCUS findings suggestive of a possible pneumothorax, tube thoracostomy was considered. However, a history of prior fundoplication for a hiatus hernia led to suspicion of a left diaphragmatic hernia. Prompt imaging with chest X-ray and non-contrast CT of the thorax confirmed the diagnosis of diaphragmatic hernia, thereby ruling out pneumothorax. Surgical intervention was promptly undertaken. This case emphasizes the importance of a thorough history and imaging before invasive procedures. Misdiagnosing a diaphragmatic hernia as a pneumothorax and proceeding with tube thoracostomy could have led to severe complications. Clinicians should maintain a high index of suspicion for alternative diagnoses in patients with a history of upper abdominal surgery presenting with chest pain and respiratory distress.

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