What is the diagnosis for a patient with an elevated left hemidiaphragm allowing bowel and abdominal contents to project over the left base, with possible coexisting airspace disease?

Differential Diagnosis

• Single most likely diagnosis
  • Diaphragmatic hernia: This is the most likely diagnosis given the elevation of the left hemidiaphragm and the presence of intra-abdominal contents, including bowel, projecting over the left base.
• Other Likely diagnoses
  • Diaphragmatic eventration: This condition, where the diaphragm is thinned and weakened, could also cause elevation of the hemidiaphragm and allow abdominal contents to herniate into the thoracic cavity.
  • Subpulmonic effusion or atelectasis: These conditions could cause elevation of the hemidiaphragm and might be obscured by the overlying abdominal contents.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bochdalek hernia: A congenital diaphragmatic hernia that can be life-threatening if not diagnosed and treated promptly.
  • Traumatic diaphragmatic rupture: A serious condition that requires immediate attention and could be masked by the presence of abdominal contents in the thoracic cavity.
• Rare diagnoses
  • Morgagni hernia: A rare type of congenital diaphragmatic hernia that occurs through an anterior defect in the diaphragm.
  • Diaphragmatic paralysis: A condition where the diaphragm is weakened or paralyzed, which could cause elevation of the hemidiaphragm and allow abdominal contents to herniate into the thoracic cavity.