Right-sided Bochdalek hernia containing retroperitoneal fat in the elderly: report of a case

Most cases of Bochdalek hernias are diagnosed during the neonatal period and arise on the left side. We report a rare case of a right-sided Bochdalek hernia in an elderly patient. A 72-year-old man presented with chest tightness and nausea. He had no history of thoracic and abdominal trauma. Preoperative CT scan showed a well-circumscribed mass in the right thoracic cavity of 28-cm diameter compressing the right lower lobe. The mass was mostly fat component and seemed to connect with retroperitoneal fat. We made some diagnoses: lipoma, liposarcoma, and diaphragmatic hernia. Surgical resection was performed by thoracotomy so as to resect the mass and repair the defect of the diaphragm. The mass seemed to be retroperitoneal fat which escaped from the hernia orifice. The neck of the mass was separated by a vessel-sealing device immediately above the hernia orifice. The defect of the diaphragm was repaired by direct suturing after completion of resection. Microscopic pathologic examination showed that the mass was maturated fat tissue. Four months postoperatively, there was no evidence of recurrence of the hernia. The diagnosis of an adult Bochdalek hernia is often difficult, so it is important to consider the examination carefully and to determine the better surgical procedure.