A middle aged patient presents with complaint of right hypochondrial pain. On plain chest x ray, elevated right hemidiaphragm is seen. All of the following are possible diagnosis except:
**Core Concept**
The patient's presentation of right hypochondrial pain and an elevated right hemidiaphragm on chest x-ray suggests an underlying condition affecting the liver, gallbladder, or diaphragm. This could involve **hepatic** or **gallbladder disease**, **diaphragmatic disorders**, or other **thoracic and abdominal pathologies**.
**Why the Correct Answer is Right**
Without the specific answer choices, we can infer that the correct answer would be a condition that does not typically cause an elevated hemidiaphragm. Conditions such as **hepatomegaly**, **liver abscess**, **cholecystitis**, or **diaphragmatic hernia** could explain the symptoms and radiographic findings.
**Why Each Wrong Option is Incorrect**
**Option A:** Could be a plausible diagnosis if it involved a condition like hepatomegaly or liver abscess.
**Option B:** Might be incorrect if it suggested a condition not typically associated with an elevated hemidiaphragm, such as a renal issue without hepatic involvement.
**Option C:** Could be a possible diagnosis if related to a condition causing diaphragmatic elevation, like a subphrenic abscess.
**Option D:** Might be the correct answer if it represented a condition unrelated to the symptoms and findings, such as a purely pulmonary issue without hepatic or diaphragmatic involvement.
**Clinical Pearl / High-Yield Fact**
An elevated hemidiaphragm can be due to various causes including **hepatic** diseases, **diaphragmatic** disorders, or **subdiaphragmatic** pathologies. Always consider the liver and gallbladder in the differential diagnosis of right hypochondrial pain.
**Correct Answer:** D. Pulmonary embolism