Unilateral Diaphragmatic Agenesis with Lung Cyst Herniating into the Abdomen Precluding Diaphragmatic Hernia in an Adult

摘要

Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated diaphragmatic hernia which has not been documented previously. Case Presentation: We report a case of previously undiagnosed complete absence of a hemidiaphragm in a 62-year-old male who presented with recurrent respiratory infection, episodes of nausea and postprandial fullness. Computed Tomography scan showed a large cyst in relation to the lower lobe of left lung. During surgery, he was found to have complete absence of a left hemidiaphragm and a large cyst arising from the lower lobe of left lung occupied the common thoracoabdominal space. Abdominal viscera were found displaced downwards and fixed in a thick fibrous membrane. There was no herniation of abdominal organs into the thoracic cavity after excision of the cyst. The left lung could be fully expanded and chest was closed after putting a chest drain. Diaphragmatic agenesis did not require any additional procedure. The cyst was excised with closure of bronchocystic opening. The patient had an uneventful recovery. Conclusions: The association of lung cyst with diaphragmatic agenesis (presented in the adulthood) is rare. It has precluded a diaphragmatic hernia and survived the patient acting as a protective barrier. The significance of lung cyst in presence of diaphragmatic agenesis lies in the absence of associated diaphragmatic hernia which has not been documented previously.