Abstract

Background: Pyothorax and diaphragmatic hernia are both common and serious diseases, but pyothorax combined with diaphragmatic hernia is rare. Pyothorax can mask the clinical and Computed Tomography (CT) manifestations of diaphragmatic hernia, leading to diagnostic errors and thus delays in diagnosis, which may lead to the patient's death. We report a case of diaphragmatic hernia combined with pyothorax. The patient underwent a complicated treatment and was finally diagnosed and cured by surgery.

Case presentation: A 71-year-old woman who was admitted to the hospital with left-sided chest pain and an outof- hospital diagnosis of left-sided pleural effusion. After admission, she was diagnosed with left-sided pyothorax after Computed Tomography (CT) examination and puncture and tube placement and diaphragmatic hernia with pyothorax was considered after surgical treatment. The patient was cured by surgery and no recurrence was observed during follow-up.

Conclusion: Diaphragmatic hernia combined with pyothorax is an extremely rare and serious disease, even leading to death and early diagnosis is extremely important. Pyothorax masks the clinical and CT manifestations of diaphragmatic hernia, thus complicating the diagnosis. Although we know that it can be cured by surgical treatment, it is difficult to make a correct and risky treatment plan without a clear diagnosis. This type of case is rarely reported and we hope that reflection on this case can further improve the diagnostic ability of clinicians.

Keywords: Diaphragmatic hernia; Pyothorax; Enterococcus faecium; Candida glabrata