Asymptomatic Diaphragmatic Dome Hernia in an Elderly Adult: Case Report and Review on Conservative Management

Background: Diaphragmatic dome hernia (DDH) is a rare condition in adults, often congenital or traumatic, involving a diaphragmatic defect allowing abdominal contents to herniate into the thorax. Late asymptomatic presentation is uncommon and diagnostically challenging. Case Presentation: A 73-year-old man with a productive cough was incidentally diagnosed with a large asymptomatic diaphragmatic hernia. Chest X-ray and thoraco-abdominal CT showed left intrathoracic colon causing left lung collapse and rightward mediastinal shift. Conservative management with clinical follow-up was chosen due to the patient’s age and stability, with no symptoms at six months. Conclusions: Asymptomatic adult DDH is rare and relies on imaging for diagnosis. Conservative management with vigilant monitoring is viable for stable patients with high surgical risks, requiring individualized risk assessment.