[A woman with right-sided decreased breath sounds].

An 89-year-old female came to the Emergency Department in acute respiratory distress and septic shock caused by a right-sided intra-thoracic incarcerated necrotic ileum. An idiopathic right-sided diaphragmatic herniation is rare. The herniation presumably occurred due to an old defect or weakness of the right-sided diaphragm post-traumatically.