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Keyes S, Spouge RJ, Kennedy P, Rai S, Abdellatif W, Sugrue G, Barrett SA, Khosa F, Nicolaou S, Murray N. Approach to Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities. Radiographics 2024; 44:e230110. [PMID: 38781091 DOI: 10.1148/rg.230110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Sarah Keyes
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Rebecca J Spouge
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Padraic Kennedy
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Shamir Rai
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Waleed Abdellatif
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Gavin Sugrue
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Sarah A Barrett
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Faisal Khosa
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Savvas Nicolaou
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
| | - Nicolas Murray
- From the Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (S.K., R.J.S., S.R., G.S., S.A.B., F.K., S.N., N.M.); Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion South, 899 W 12th Ave, Room G861, Vancouver, BC, Canada V5Z 1M9 (R.J.S., P.K., S.R., G.S., S.A.B., F.K., S.N., N.M.); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (W.A.)
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Yongue C, Geraci TC, Chang SH. Management of Diaphragm Paralysis and Eventration. Thorac Surg Clin 2024; 34:179-187. [PMID: 38705666 DOI: 10.1016/j.thorsurg.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
An elevated diaphragm may be due to eventration or paralysis. Diaphragm elevation is often asymptomatic and found incidentally on imaging. Fluoroscopic testing can be used to differentiate eventration (no paradoxic motion) from paralysis (paradoxic motion). Regardless of etiology, a diaphragm plication is indicated in all symptomatic patients with an elevated diaphragm. Plication can be approached either from a thoracic or abdominal approach, though most thoracic surgeons perform minimally invasive thoracoscopic plication. The goal of plication is to improve lung volumes and decrease paradoxic elevation of the hemidiaphragm. Diaphragm plication is safe, has excellent outcomes, and is associated with symptom improvement.
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Affiliation(s)
- Camille Yongue
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, New York University Langone Health, 530 First Avenue, Suite 9V, New York, NY 10016, USA.
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Tasnim S, Bribriesco AC, Sudarshan M. Surgical Diaphragm: Anatomy and Physiology. Thorac Surg Clin 2024; 34:111-118. [PMID: 38705658 DOI: 10.1016/j.thorsurg.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The diaphragm is a musculoaponeurotic structure separating the thoracic and abdominal cavities. It plays important roles in both respiration and maintaining gastrointestinal function. A careful consideration of anatomy should be taken during surgical procedures to minimize injury to this crucial organ.
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Affiliation(s)
- Sadia Tasnim
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. https://twitter.com/_SadiaTasnim
| | - Alejandro C Bribriesco
- Department of Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. https://twitter.com/abribriesco43
| | - Monisha Sudarshan
- Department of Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Hu S, Yang X, Wu Y. Displacement of Abdominal Organs Into the Thoracic Cavity: A Rare Case of Adult Bochdalek Hernia. Cureus 2024; 16:e56950. [PMID: 38533320 PMCID: PMC10965112 DOI: 10.7759/cureus.56950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 03/28/2024] Open
Abstract
Congenital diaphragmatic hernias are primarily found in infants and have a high mortality rate due to neonatal respiratory distress. The most common type of congenital diaphragmatic hernia is Bochdalek hernia, which occurs in the posterolateral diaphragm, with the left side being the most commonly affected. However, congenital diaphragmatic hernias are extremely rare in adults and are often misdiagnosed due to their subtle symptoms. Therefore, we suggest that a contrast-enhanced CT scan should be used for early screening and diagnosis in all patients with sudden severe pain or recurrent ambiguous symptoms in the chest and abdomen. This case report presents a rare occurrence of Bochdalek hernia in an adult male. The patient experienced nonspecific abdominal symptoms after eating. The hernia resulted in the displacement of the left kidney, the transverse colon of the splenic flexure, and most of the stomach into the thoracic cavity. This displacement led to atelectasis of the left lung, which reached three-fifths of its capacity. The patient underwent successful treatment using a combination of laparoscopy and open surgery. Follow-up CT scans conducted two weeks, three months, and one year later revealed a stable condition with no complications.
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Affiliation(s)
- Sien Hu
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Xiaohui Yang
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Yulian Wu
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
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Predescu D, Achim F, Socea B, Ceaușu MC, Constantin A. Rare Diaphragmatic Hernias in Adults-Experience of a Tertiary Center in Esophageal Surgery and Narrative Review of the Literature. Diagnostics (Basel) 2023; 14:85. [PMID: 38201394 PMCID: PMC10795705 DOI: 10.3390/diagnostics14010085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
A rare entity of non-hiatal type transdiaphragmatic hernias, which must be clearly differentiated from paraoesophageal hernias, are the phrenic defects that bear the generic name of congenital hernias-Bochdalek hernia and Larey-Morgagni hernia, respectively. The etiological substrate is relatively simple: the presence of preformed anatomical openings, which either do or do not enable transit from the thoracic region to the abdominal region or, most often, vice versa, from the abdomen to the thorax, of various visceral elements (spleen, liver, stomach, colon, pancreas, etc.). Apart from the congenital origin, a somewhat rarer group is described, representing about 1-7% of the total: an acquired variant of the traumatic type, frequently through a contusive type mechanism, which produces diaphragmatic strains/ruptures. Apparently, the symptomatology is heterogeneous, being dependent on the location of the hernia, the dimensions of the defect, which abdominal viscera is involved through the hernial opening, its degree of migration, and whether there are volvulation/ischemia/obstruction phenomena. Often, its clinical appearance is modest, mainly incidental discoveries, the majority being digestive manifestations. Severe digestive complications such as strangulation, volvus, and perforation are rare and are accompanied by severe shock, suddenly appearing after several non-specific digestive prodromes. Diagnosis combines imaging evaluations (plain radiology, contrast, CT) with endoscopic ones. Surgical treatment is recommended regardless of the side on which the diaphragmatic defect is located or the secondary symptoms due to potential complications. The approach options are thoracic, abdominal or combined thoracoabdominal approach, and classic or minimally invasive. Most often, selection of the type of approach should be made taking into account two elements: the size of the defect, assessed by CT, and the presence of major complications. Any hiatal defect that is larger than 5 cm2 (the hiatal hernia surface (HSA)) has a formal recommendation of mesh reinforcement. The recurrence rate is not negligible, and statistical data show that the period of the first postoperative year is prime for recurrence, being directly proportional to the size of the defect. As a result, in patients who were required to use mesh, the recurrence rate is somewhere between 27 and 41% (!), while for cases with primary suture, i.e., with a modest diaphragmatic defect, this is approx. 4%.
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Affiliation(s)
- Dragos Predescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Florin Achim
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Surgery, “Sf. Pantelimon” Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Mihail Constantin Ceaușu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- Department of Histopathology, Alexandru Trestioreanu” National Institute of Oncology, 022328 Bucharest, Romania
| | - Adrian Constantin
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.P.); (B.S.); (M.C.C.); (A.C.)
- General and Esophageal Clinic, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
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Konstantinidi A, Liakou P, Kopanou Taliaka P, Lampridou M, Kalatzi N, Loukas I, Tavoulari EF, Mitropoulos K, Koulopoulos K, Sokou R. Congenital Diaphragmatic Eventration in the Neonatal Period: Systematic Review of the Literature and Report of a Rare Case Presenting with Gastrointestinal Disorders. Pediatr Rep 2023; 15:442-451. [PMID: 37606445 PMCID: PMC10443257 DOI: 10.3390/pediatric15030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The term congenital diaphragmatic eventration (CDE) refers to an anatomical abnormality of the diaphragm. It is a very rare condition; however, early and prompt diagnosis is of very great importance due to possible life-threatening complications. Most severely affected patients are neonates, usually presented with respiratory distress symptoms. The aim of this study was to systematically review the existing literature and to consolidate data on CDE in neonates as well as to report a case of a neonate with congenital diaphragmatic eventration of the left hemidiaphragm and clinical signs and symptoms of the gastrointestinal tract. METHODS An electronic search of the PubMed and Scopus databases was performed regarding studies evaluating the clinical presentation, diagnosis methods, treatments, and outcomes of CDE in the neonatal population. RESULTS Data from 93 studies were integrated into our review, reporting 204 CDE cases, and according to them, the male/female ratio was 1/1 with a predominance of right-sided eventration. The diagnosis was primarily established by chest X-ray; surgical intervention was the most frequent treatment. The recurrence rate was 8.3% (9/109 cases). CONCLUSIONS Early and accurate diagnosis of CDE and repair of the diaphragm can prevent complications, reduce morbidity, and improve the quality of patient's life.
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Affiliation(s)
- Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Paraskevi Liakou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Paschalia Kopanou Taliaka
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Maria Lampridou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Nicoletta Kalatzi
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Ierotheos Loukas
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Konstantinos Mitropoulos
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
| | - Konstantinos Koulopoulos
- Pediatric Surgery Department, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (N.K.); (I.L.); (K.K.)
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, Nikea General Hospital “Agios Panteleimon”, 18454 Piraeus, Greece; (A.K.); (P.L.); (P.K.T.); (M.L.); (E.-F.T.); (K.M.)
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Orlandi G, Toscano P, Gabrielli O, Di Lella E, Lettieri A, Manzo L, Mazzarelli LL, Sica C, Di Meglio L, Di Meglio L, Gulino FA, Incognito GG, Tuscano A, Cianci S, Di Meglio A. Prenatal Diagnosis of an Intrathoracic Left Kidney Associated with Congenital Diaphragmatic Hernia: Case Report and Systematic Review. J Clin Med 2023; 12:jcm12113608. [PMID: 37297803 DOI: 10.3390/jcm12113608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association. CASE PRESENTATION A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful. CONCLUSIONS CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
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Affiliation(s)
- Giuliana Orlandi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Paolo Toscano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Olimpia Gabrielli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Enrica Di Lella
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Antonia Lettieri
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Luigi Manzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Carmine Sica
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
| | - Letizia Di Meglio
- Radiology Department, School of Medicine, University of Milan, 20133 Milan, Italy
| | - Lavinia Di Meglio
- Pediatric Department, Bambino Gesù Children's Research Hospital IRCCS, 00165 Rome, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Attilio Tuscano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Stefano Cianci
- Department of Human Pathology of Adult and Childhood "G. Barresi", University of Messina, 98121 Messina, Italy
| | - Aniello Di Meglio
- Diagnostica Ecografica e Prenatale di A. Di Meglio, 80133 Naples, Italy
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8
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Alzahrani KM. Sleeve Gastrectomy in a Patient With Left Hemidiaphragm Paralysis: A Case Report. Cureus 2022; 14:e27048. [PMID: 35989777 PMCID: PMC9389028 DOI: 10.7759/cureus.27048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 12/04/2022] Open
Abstract
Unilateral diaphragmatic paralysis is a disorder in which one side of the diaphragm loses the capacity to contract to allow for adequate inspiration. The majority of patients suffering from unilateral diaphragmatic paralysis are asymptomatic and do not require treatment. The laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgical operation. In this case report, I present the case of a 36-year-old male with congenital left hemidiaphragm paralysis who had LSG for the treatment of morbid obesity. This case demonstrates the efficacy and feasibility of LSG in patients with asymptomatic hemidiaphragm paralysis. During surgery, surgeons must pay close attention to a variety of factors, including a stomach fundus that is situated high in a subcostal region with a narrow space to work.
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9
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Mitsiakos G, Gavras C, Katsaras GN, Chatziioannidis I, Mouravas V, Mitsiakou C, Lampropoulos V, Nikolaidis N. Parvovirus B19 Intrauterine Infection and Eventration of the Diaphragm. Prague Med Rep 2022; 123:48-55. [PMID: 35248165 DOI: 10.14712/23362936.2022.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring, cleft lip and hypospadias, as well myocarditis and congenital heart disease have been reported. We present a case of a preterm female neonate born with ascites, hydrothorax and congenital diaphragmatic eventration (CDE), with a prenatal diagnosis of congenital diaphragmatic hernia (CDH). The neonate was born prematurely at 32 weeks gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room, transferred in the Neonatal Intensive Care Unit (NICU) and supported with high frequency oscillatory ventilation (HFOV). The diagnosis of CDH was sonographically estimated from the 20th week of gestation and surgical correction was decided. During surgery CDE was diagnosed instead of CDH and despite postoperatively care the neonate developed disseminated intravascular coagulation and finally died in the 40th hour of life. Along with the identification of parvovirus B19 in the pleural fluid by PCR, the biopsy of the diaphragm revealed connective tissue, full of vasculature and absence muscle tissue. Although only cytomegalovirus, rubella, and toxoplasmosis were considered to be associated with CDE, parvovirus B19 might also be related to this congenital diaphragmatic malformation. In CDE, the function of the lungs can be compromised as a consequence of the compression applied by the abdominal organs. The neonatologists should include this condition in their differential diagnosis for a more direct and effective management.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Christoforos Gavras
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Georgios N Katsaras
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Ilias Chatziioannidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Mouravas
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Christina Mitsiakou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Lampropoulos
- 2nd Department of Pediatric Surgery, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Nikolaos Nikolaidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
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10
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Khan W, Safi A, Ahmad A, Mooghal M. A case of Bochdalek hernia with anomalous hepatic lobe heterotopia-case report. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bochdalek hernia is the most common type of congenital diaphragmatic hernia (CDH) resulting from postero-lateral diaphragmatic defect. Hepatic heterotopia is very rarely associated with CDH, and hepatic herniation favors the worst prognosis.
Case presentation
We present a case of a neonate diagnosed with right Bochdalek hernia (BH) with anomalous hepatic lobe heterotopia. Intra operatively, mal-rotated loops were also found to be herniating in the right hemithorax. The mal-rotated loops were reduced back into abdomen after performing Ladd’s procedure and diaphragmatic defect was repaired over the anomalous liver lobe. Baby was discharged on 7th postoperative day and follow-ups showed good recovery.
Conclusion
This case report discusses the presentation, classification, and significance of this association. Our case report is noteworthy as Bochdalek hernia is very rarely associated with anomalous hepatic lobe.
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11
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Graan D, Amico F, Wills VL, Balogh ZJ. Subtle sign of diaphragm rupture involving the oesophageal hiatus. ANZ J Surg 2021; 92:546-548. [PMID: 34223692 DOI: 10.1111/ans.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- David Graan
- John Hunter Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Francesco Amico
- John Hunter Department of Traumatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Vanessa L Wills
- Department of General Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology and Discipline of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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12
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Sher M, Gopalakaje S, Justo R, Choo K, Kapur N. Rare case of Morgagni hernia presenting with cyanotic spells in a neonate. J Paediatr Child Health 2021; 57:289-292. [PMID: 32173927 DOI: 10.1111/jpc.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/26/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mustafa Sher
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Saikiran Gopalakaje
- Respiratory Division, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Robert Justo
- Respiratory Division, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kelvin Choo
- Surgery Division, Mater Children's Private Hospital, Brisbane, Queensland, Australia
| | - Nitin Kapur
- Respiratory Division, Queensland Children's Hospital, Brisbane, Queensland, Australia
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13
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14
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Halle-Smith JM, Pande R, Griffiths EA. Urgent surgical repair of symptomatic Bochdalek hernia containing an intrathoracic kidney. Ann R Coll Surg Engl 2020; 103:e10-e12. [PMID: 32829650 DOI: 10.1308/rcsann.2020.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bochdalek hernias rarely contain an intrathoracic kidney, and there are few reports of their operative repair. A woman presented with progressive dyspnoea limiting her quality of life. Imaging showed a Bochdalek hernia containing omentum, large bowel and the left kidney. The woman was unexpectedly admitted to the intensive care unit with respiratory failure secondary to gallstone pancreatitis whilst awaiting elective repair of her hernia. Surgical repair of the hernia was performed via laparotomy with cholecystectomy to treat both problems. The woman recovered well and is independently mobile without any exertional dyspnoea.
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Affiliation(s)
| | - R Pande
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - E A Griffiths
- University Hospitals Birmingham NHS Foundation Trust, UK
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15
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Abstract
Congenital and hereditary cystic lesions of the abdomen are relatively rare. Correct diagnosis is critical as they may simulate several other benign and malignant acquired diseases of the abdomen. With the correct and appropriate use of imaging, diagnosis may be relatively straightforward and clinical management may be implemented appropriately. The purpose of this article is to describe imaging findings of common and uncommon congenital and hereditary cystic disease of the abdominal organs.
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16
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Kumar A, Karn R, Khanal B, Sah SP, Gupta R. Laparoscopic approach for diaphragmatic hernia repair in adult: our experience of four cases. J Surg Case Rep 2020; 2020:rjaa178. [PMID: 32595927 PMCID: PMC7303022 DOI: 10.1093/jscr/rjaa178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory/gastrointestinal symptoms and occasionally atypical presentation as lumbar hernia also. The diagnosis of diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray film and computed tomography scan. Various treatment approaches, open, laparoscopic and combination, are available for this condition. However, laparoscopic approach has recently gained in popularity. Surgical repair typically involves primary or patch closure of the diaphragm through an open or endoscopic abdominal or thoracic approach. This paper reflects our experience of repair of diaphragmatic hernias to evaluate its safety, efficacy and outcomes.
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Affiliation(s)
- Abhijeet Kumar
- Department of Surgery, BPKIHS, Dharan, Nepal
- Correspondence address. Department of Surgery, BPKIHS, Buddha Road, Dharan, Nepal. Tel: 00977-9819320919; Fax: 00977-25-520251; E-mail:
| | - Ratish Karn
- Department of Surgery, BPKIHS, Dharan, Nepal
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17
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Bilateral Bochdalek Hernias Associated with Arnold-Chiari I Malformation. Case Rep Radiol 2020; 2020:1931879. [PMID: 32047696 PMCID: PMC7007740 DOI: 10.1155/2020/1931879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
A Bochdalek hernia is a posterolateral diaphragmatic defect that is either congenital or acquired. The contents of the hernia range from fat to intra-abdominal organs. They are primarily pathologies of neonates and most commonly occur unilaterally. These hernias have been described in isolation and as one part of a group of malformations. There have been reports of Bochdalek hernias in association with myelomeningocele and other neural tube defects. We present a unique case of bilateral Bochdalek hernias in a 35-year-old female with an Arnold-Chiari I malformation.
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18
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Mizzi C, Farrugia D, Choudhry MS. Congenital Diaphragmatic Hernia with Intrathoracic Renal Ectopia: Thoracoscopic Approach for a Complete Anatomical Repair. European J Pediatr Surg Rep 2020; 8:e74-e76. [PMID: 33101834 PMCID: PMC7577787 DOI: 10.1055/s-0039-3402741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital diaphragmatic herniae (CDH) with associated intrathoracic ectopic kidneys are rare congenital anomalies, with a reported incidence of only 0.25%. The authors report a case of a 24-day-old baby girl who was diagnosed with a left-sided CDH on a chest X-ray taken for pneumonia. Computed tomography scan showed CDH hernia, containing small and large bowel and whole left kidney with adrenal gland. Thoracoscopic reduction in the bowel, kidney, and adrenal gland into the abdomen and primary closure of the defect was achieved with no complications. During investigation of the child, it was discovered that her maternal aunt had also had a left-sided congenital diaphragmatic hernia containing the kidney, which was treated via open surgery after birth; she subsequently developed renal cell carcinoma and required radical nephrectomy of that kidney during her third decade.
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Affiliation(s)
- Colin Mizzi
- Department of Paediatric Surgery, Mater Dei Hospital, Msida, Malta
| | | | - Muhammad S. Choudhry
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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19
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Kandemirli SG, Sancar S, Ozcakir E, Parlak A, Bilgin C, Gurpinar AN, Yazici Z, Kaya M. Cross-sectional imaging and laparoscopic findings of diaphragmatic mesothelial cysts. Clin Radiol 2019; 75:239.e9-239.e14. [PMID: 31785781 DOI: 10.1016/j.crad.2019.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
AIM To present cross-sectional imaging, surgical findings, and follow-up results of diaphragmatic mesothelial cysts. MATERIALS AND METHODS Radiological findings for location, size, shape, and internal structure of cysts were reviewed retrospectively. For patients that underwent surgery, surgical reports and laparoscopy images were reviewed. In conservatively managed patients, changes in size and imaging findings of the cyst were assessed during follow-up visits. RESULTS A total of 13 paediatric cases with an imaging and/or pathological diagnosis of diaphragmatic mesothelial cyst were identified. In all cases, the cystic lesions were located between the diaphragm and the posterolateral aspect of the right lobe of the liver. Eleven lesions (84.6%) had a bi-lobulate shape. Eight of these cases underwent laparoscopic cyst aspiration/unroofing. The postoperative course was uneventful and there were no cases of recurrence. The remaining five cases were managed conservatively with follow-up available in four cases. In three cases (75%), there was reduction in the size of the cysts with a mean volume reduction of 55%. CONCLUSION Diaphragmatic mesothelial cysts are congenital cystic lesions that are usually detected incidentally. A common pitfall is incorrect interpretation of the lesion as a hepatic cyst. Conservative management with imaging follow-up can be adopted in asymptomatic cases with typical imaging findings.
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Affiliation(s)
- S G Kandemirli
- Department of Radiology, University of Iowa Hospital and Clinics, IA, USA; Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey.
| | - S Sancar
- Department of Pediatric Surgery, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
| | - E Ozcakir
- Department of Pediatric Surgery, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
| | - A Parlak
- Department of Pediatric Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - C Bilgin
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A N Gurpinar
- Department of Pediatric Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Z Yazici
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - M Kaya
- Department of Pediatric Surgery, Sevket Yilmaz Education and Research Hospital, Bursa, Turkey
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20
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Muthu V, Sagar S, Sehgal IS, Thurai Prasad K, Dhooria S, Singla V, Agarwal R. A 19-Year-Old Young Man With Breathlessness and Opacity in the Left Hemithorax. Chest 2019; 156:e1-e4. [PMID: 31279379 DOI: 10.1016/j.chest.2018.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/14/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sathya Sagar
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veenu Singla
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine and Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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21
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Castro BA, Novillo IC, Vázquez AG, Garcia PY, Herrero EF, Fraile AG. IMPACT OF THE APPENDICEAL POSITION ON THE DIAGNOSIS AND TREATMENT OF PEDIATRIC APPENDICITIS. REVISTA PAULISTA DE PEDIATRIA 2019; 37:161-165. [PMID: 30892542 PMCID: PMC6651307 DOI: 10.1590/1984-0462/;2019;37;2;00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
Objective: To investigate how symptoms vary according to the appendiceal position in pediatric patients and to demonstrate that the laparoscopic approach is safe and effective in any appendiceal location by comparing each location to another. Methods: The medical records of 1,736 children aged 14 or younger who underwent laparoscopic appendectomy over a period of 14 years were analyzed retrospectively. Patients were divided according to the position of the appendiceal tip into four groups: anterior, pelvic, retrocecal and subhepatic. The Kruskal-Wallis and chi-square tests were used with the Bonferroni correction, with a significant p<0.05. Results: The appendiceal location was anterior in 1,366 cases, retrocecal in 248 cases, pelvic in 66 cases and subhepatic in 56 cases. There were no significant differences between the groups in terms of patient age and gender. Abdominal pain was the only symptom with statistically significant differences between the groups. The rate of perforated appendicitis was higher in the subhepatic and pelvic positions. Intraoperative complications and conversions were not statistically significant. Technical difficulties and operative time were higher in subhepatic position. The rate of postoperative complications was similar between the different locations, except for bowel obstruction, which was higher in pelvic appendicitis. Conclusions: The clinical symptoms of appendicitis hardly ever change with the position of the appendix. The laparoscopic approach is safe and effective, regardless the appendiceal location.
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22
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Joshi A, Kumar M, Acharya A. Bilateral congenital eventration of diaphragm: keep in mind, the other side. BMJ Case Rep 2018; 2018:bcr-2018-226051. [PMID: 30317202 DOI: 10.1136/bcr-2018-226051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Eventration of diaphragm is an uncommon disorder in which diaphragmatic muscle is replaced by fibroelastic tissue, either partially or completely. Bilateral eventration is even rarer. We present a case of bilateral eventration of diaphragm in newborn with a fibroelastic sac on left side and diaphragmatic eventration with good muscular lips on right side. The right-sided diaphragmatic eventration was not evident initially, but manifested after surgical repair of the left-sided eventration.
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Affiliation(s)
- Avadhesh Joshi
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abhilipsa Acharya
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
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23
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Souza Neto JRNDE, Branco É, Giese EG, Lima ARDE. Morphological Characterization of Diaphragm in Common Squirrel Monkey (Saimiri sciureus). AN ACAD BRAS CIENC 2018; 90:169-178. [PMID: 29466481 DOI: 10.1590/0001-3765201820170167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/11/2017] [Indexed: 11/21/2022] Open
Abstract
The wall of the diaphragm can be affected by congenital or acquired alterations which allow the passage of viscera between the abdominal and chest cavities, allowing the formation of a diaphragmatic hernia. We characterized morphology and performed biometrics of the diaphragm in the common squirrel monkey Saimiri sciureus. After fixation, muscle fragments were collected and processed for optical microscopy. In this species the diaphragm muscle is attached to the lung by phrenopericardial ligament. It is also connected to the liver via the coronary and falciform ligaments. The muscle is composed of three segments in total: 1) sternal; 2) costal, and 3) a segment consisting of right and left diaphragmatic pillars. The anatomical structures analyzed were similar to those reported for other mammals. Histological analysis revealed stable, organized muscle fibers with alternation of light and dark streaks, indicating transverse striation.
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Affiliation(s)
- José Ricardo N DE Souza Neto
- Laboratório de Pesquisa Morfológica Animal/LaPMA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Érika Branco
- Laboratório de Pesquisa Morfológica Animal/LaPMA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Elane G Giese
- Laboratório de Histologia e Embriologia Animal/LHEA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
| | - Ana Rita DE Lima
- Laboratório de Histologia e Embriologia Animal/LHEA, Faculdade de Medicina Veterinária, Universidade Federal Rural da Amazônia/UFRA, Avenida Presidente Tancredo Neves, 2501, Montese, 66077-530 Belém, PA, Brazil
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24
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Kokatnur L, Rudrappa M. Diaphragmatic Palsy. Diseases 2018; 6:E16. [PMID: 29438332 PMCID: PMC5871962 DOI: 10.3390/diseases6010016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy. Diaphragmatic movements with respiration can be directly visualized by fluoroscopic examination. Currently, this test is being replaced by bedside thoracic ultrasound examination, looking at the diaphragmic excursion with deep breathing or sniffing. This test is found to be equally efficient, and without risks of ionizing radiation of fluoroscope. Treatment of diaphragmatic palsy depends on the cause. Surgical approach of repair of diaphragm or nonsurgical approach of noninvasive ventilation has been tried with good success. Overall prognosis of diaphragmatic palsy is good, except when it is related to neuromuscular degeneration conditions.
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Affiliation(s)
- Laxmi Kokatnur
- Department of Neurology, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Neurology, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Neurology, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
| | - Mohan Rudrappa
- Department of Pulmonary and Critical Care Medicine, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 711031, USA.
- Department of Pulmonary and Critical Care Medicine, Overton Brooks VA Medical Center, 501 E Stoner Ave, Shreveport, LA 71101, USA.
- Department of Pulmonary and Critical Care Medicine, Mercy Hospital, 100 Mercy Way, Joplin, MO 64804, USA.
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25
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Turmak M, Deniz MA, Özmen CA, Aslan A. Evaluation of the multi-slice computed tomography outcomes in diaphragmatic injuries related to penetrating and blunt trauma. Clin Imaging 2017; 47:65-73. [PMID: 28898729 DOI: 10.1016/j.clinimag.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/13/2017] [Accepted: 08/29/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Traumatic diaphragmatic rupture is a diagnostic challenge for both surgeons and radiologists and generally occurs secondary to blunt and penetrating trauma of thoracoabdominal region. MATERIAL AND METHODS 56 patients who underwent surgical procedure due to blunt or penetrating trauma were included to the study. RESULTS There were 37 diaphragmatic ruptures in the left side and 19 patients in the right side. The most common radiological finding was "the direct monitoring of defect" (54,3%). CONCLUSION Findings suggestive of diaphragmatic rupture must be carefully evaluated in patients with blunt or penetrating thoracoabdominal trauma.
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Affiliation(s)
- Mehmet Turmak
- Department of Radiology, Van Special Güven Hospital, Van, Turkey
| | - Muhammed Akif Deniz
- Department of Radiology, Health Scıence Unıversity Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey.
| | - Cihan Akgül Özmen
- Department of Radiology, Dicle University School of Medical Science, Diyarbakir, Turkey
| | - Aydın Aslan
- Department of Radiology, Health Scıence Unıversity Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
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26
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Podgaetz E, Garza-Castillon R, Andrade RS. Best Approach and Benefit of Plication for Paralyzed Diaphragm. Thorac Surg Clin 2017; 26:333-46. [PMID: 27427528 DOI: 10.1016/j.thorsurg.2016.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diaphragmatic eventration and diaphragmatic paralysis are 2 entities with different etiology and pathology, and are often clinically indistinguishable. When symptomatic, their treatment is the same, with the objective to reduce the dysfunctional cephalad excursion of the diaphragm during inspiration. This can be achieved with diaphragmatic plication through the thorax or the abdomen with either open or minimally invasive techniques. We prefer the laparoscopic approach, due to its easy access to the diaphragm and to avoid pain associated with intercostal incisions and instrument use. Short-term and long-term results are excellent with this technique.
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Affiliation(s)
- Eitan Podgaetz
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA.
| | - Rafael Garza-Castillon
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
| | - Rafael S Andrade
- Section of Thoracic and Foregut Surgery, Division of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 207, Minneapolis, MN 55455, USA
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27
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Kohli N, Mitreski G, Yap CH, Leong M. Massive symptomatic right-sided Bochdalek hernia in an adult man. BMJ Case Rep 2016; 2016:bcr-2016-217432. [PMID: 27852660 DOI: 10.1136/bcr-2016-217432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 22-year-old man presented to a rural hospital in Australia with right-sided pleuritic chest pain, right shoulder pain and dyspnoea. The patient had been receiving chronic asthma therapy without improvement. CT of the chest was performed after an abnormal X-ray, incidentally revealing one of the largest documented right-sided diaphragmatic hernias, with left lung compression due to mediastinal shift. The patient was definitively managed with thoracotomy alone. The contents of the hernia sac included colon and multiple loops of small bowel with a 10 cm neck. Definitive treatment was achieved with significant reduction in hernia size and formation of a neo-diaphragm with composite mesh. The postoperative period was complicated only by a wound infection. Two weeks after discharge the patient remained clinically well. Repeat chest X-ray showed no recurrence of the hernia. Congenital diaphragmatic hernias should be considered in patients with ongoing respiratory symptoms. Thoracotomy provides a safe approach.
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Affiliation(s)
- Naman Kohli
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Goran Mitreski
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Cheng-Hon Yap
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Matthew Leong
- Department of Surgery, Barwon Health, Geelong, Victoria, Australia
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28
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Kahriman G, Ozcan N, Dogan S, Bayram A. Imaging findings and management of diaphragmatic mesothelial cysts in children. Pediatr Radiol 2016; 46:1546-51. [PMID: 27350378 DOI: 10.1007/s00247-016-3658-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/08/2016] [Accepted: 06/08/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Diaphragmatic mesothelial cysts are rare benign congenital lesions with typical imaging findings. OBJECTIVE To present imaging and treatment outcomes in 30 children with diaphragmatic mesothelial cyst. MATERIALS AND METHODS We conducted a retrospective chart review and recorded demographic data, imaging findings, treatment and US follow-up results, initial and final volume of the cysts and length of follow-up period for each case of diaphragmatic mesothelial cyst in a specialist hospital. RESULTS The study included 30 children (16 girls, age range 1-17 years, mean age 7.9 years) diagnosed with diaphragmatic mesothelial cyst between January 2010 and December 2015. Imaging findings included thin-walled bilobulated or oval-shape cysts located between the diaphragm and right lobe of the liver. Treatment consisted of percutaneous drainage in 17 children and was successful in all. Cysts disappeared completely in 12 of these 17 children (70.5%, 95% confidence interval [CI] 44-90%). Mean volume reduction was 98%. No complication or mortality was seen. The other 13 children were followed with US without treatment. In 4 of these 13 children (30.8%, 95% CI 9-61%), cysts spontaneously decreased in size. No cyst increased in size. CONCLUSION In children with typical imaging findings, percutaneous drainage appears safe and effective when treatment is deemed necessary.
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Affiliation(s)
- Guven Kahriman
- Department of Radiology, Medical Faculty, Gevher Nesibe Hospital, Erciyes University, 38039, Kayseri, Turkey.
| | - Nevzat Ozcan
- Department of Radiology, Medical Faculty, Gevher Nesibe Hospital, Erciyes University, 38039, Kayseri, Turkey
| | - Serap Dogan
- Department of Radiology, Medical Faculty, Gevher Nesibe Hospital, Erciyes University, 38039, Kayseri, Turkey
| | - Adnan Bayram
- Department of Anesthesiology, Gevher Nesibe Hospital, Erciyes University, Kayseri, Turkey
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Bochdalek-type Diaphragmatic Hernia Leading to High-grade Kidney Obstruction. Urology 2016; 97:e17-e18. [PMID: 27567947 DOI: 10.1016/j.urology.2016.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 11/23/2022]
Abstract
A 94-year-old female presented with sharp right flank pain. Imaging demonstrated herniation of the right renal pelvis and proximal ureter into a large diaphragmatic hernia. She underwent ureteral stent placement with resolution of her symptoms. Congenital diaphragmatic hernias can cause a variety of pulmonary, cardiac, and gastrointestinal symptoms. This is 1 of only 3 cases in the literature of unilateral kidney obstruction due to herniation of the renal pelvis and proximal ureter into a Bochdalek-type diaphragmatic hernia. Ureteral stenting is a good option to decompress the kidney. Hernia reduction and primary diaphragm repair remain the definitive treatment.
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Sun Q, Wang BY, Wang QS, Tan Q. Bochdalek hernia as unusual cause of massive hydrothorax in a 50-year-old man. Thorax 2016; 71:774-5. [PMID: 27103347 DOI: 10.1136/thoraxjnl-2016-208590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/29/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Qiang Sun
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Bao-Ying Wang
- Department of Clinical Laboratory, The Third Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Qing-Sheng Wang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
| | - Qiang Tan
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China
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Machado NO. Laparoscopic Repair of Bochdalek Diaphragmatic Hernia in Adults. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:65-74. [PMID: 27042603 PMCID: PMC4791901 DOI: 10.4103/1947-2714.177292] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.
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Bhatti UH, Dawani S. Large bowel obstruction complicating a posttraumatic diaphragmatic hernia. Singapore Med J 2015; 56:e56-8. [PMID: 25917476 DOI: 10.11622/smedj.2015061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Posttraumatic diaphragmatic hernia is a rare cause of large bowel obstruction, and can present weeks or years after the initial trauma. Herein, we report the case of a 28-year-old man who presented with signs and symptoms of bowel obstruction nine months after he had a stab wound to his left chest. Chest radiography showed multiple air‑fluid levels in the right upper quadrant, an air-fluid level in the left thoracic cavity and significant free air under the diaphragm. Exploratory laparotomy revealed a contaminated abdomen with perforations in the caecum and proximal transverse colon, and a 4 cm × 4 cm defect in the left posterolateral (septal) aspect of the diaphragm, which was closed with a nonabsorbable suture. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis.
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Affiliation(s)
- Umer Hasan Bhatti
- Department of Surgery Ward 21, Jinnah Postgraduate Medical Centre, Karachi, Pakistan 75510.
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33
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Juricic M, Cambon Z, Baunin C, Abbo O, Puget C, Crouzet K, Galinier P, Bouali O. Prenatal diagnosis of right-sided diaphragmatic hernia and ipsilateral intrathoracic kidney in a female fetus: a rare observation. Surg Radiol Anat 2015; 38:419-23. [DOI: 10.1007/s00276-015-1575-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023]
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34
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Cessans C, Pharamin J, Crouzet K, Kessler S, Puget C, Bouali O, Galinier P, Marcoux MO. [Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: a combination with a good prognosis]. Arch Pediatr 2015; 22:1176-9. [PMID: 26385648 DOI: 10.1016/j.arcped.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/10/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
Abstract
Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination.
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Affiliation(s)
- C Cessans
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France.
| | - J Pharamin
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - K Crouzet
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - S Kessler
- Centre de dépistage des Carmes, 31000 Toulouse, France
| | - C Puget
- Centre de radiologie rive gauche, clinique Sarrus-Teinturiers, 31100 Toulouse, France
| | - O Bouali
- Service de chirurgie viscérale pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - P Galinier
- Service de chirurgie viscérale pédiatrique, hôpital des enfants, 31100 Toulouse, France
| | - M-O Marcoux
- Service de réanimation pédiatrique, hôpital des enfants, 31100 Toulouse, France
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35
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Ahmad M, Al-Arifi A, Najm HK. Giant Hernia of Morgagni with Acute Coronary Syndrome: A Rare Case Report and Review of Literature. Heart Lung Circ 2015; 24:e144-7. [DOI: 10.1016/j.hlc.2015.04.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 11/30/2022]
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36
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Late Onset Traumatic Diaphragmatic Herniation Leading to Intestinal Obstruction and Pancreatitis: Two Separate Cases. Case Rep Emerg Med 2015; 2015:549013. [PMID: 26380126 PMCID: PMC4561313 DOI: 10.1155/2015/549013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/16/2015] [Indexed: 11/18/2022] Open
Abstract
Although diaphragmatic injuries caused by blunt or penetrating trauma are rare entities, they are the most commonly misdiagnosed injuries in trauma patients and occur in approximately 3–7% of all abdominal or thoracic traumas. Acute pancreatitis secondary to late presenting diaphragmatic hernia is very rare. Here we present two separate cases: one with acute bowel obstruction and the other with acute pancreatitis secondary to late onset traumatic diaphragmatic hernia (three and twenty-eight years after chest trauma, resp.).
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37
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Wu S, Zang N, Zhu J, Pan Z, Wu C. Congenital diaphragmatic eventration in children: 12 years' experience with 177 cases in a single institution. J Pediatr Surg 2015; 50:1088-92. [PMID: 25783408 DOI: 10.1016/j.jpedsurg.2014.09.055] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/13/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study sought to summarize the diagnostic and treatment aspects of congenital diaphragmatic eventration (CDE) in children by retrospectively analyzing their medical records to identify and understand the complications of CDE, its treatment, and to evaluate the long-term outcomes of diaphragmatic plication. METHODS The medical records of children who received treatment for CDE from January 2000 to December 2011 at the Children's Hospital of Chongqing Medical University, China were analyzed. Data analyzed included the following: age, sex, symptom, location of eventration, associated anomalies, surgical procedures, complications, and survival and follow up details after diaphragmatic plication. RESULTS The medical records of 177 children (boys: 128, girls: 49, mean age: 10.28±2.35 months) with CDE were included in this study. Specific symptoms of eventration of the diaphragm were reported for 86 cases; and the typical symptoms included rapid breathing, vomiting, and recurrent respiratory infections. Except for a bilateral case, all the other patients had unilateral CDE. Associated malformations were observed in 31 cases (17.5%), hypoplastic lung (10 cases) was the most common followed by congenital heart disease (9 cases), and cryptorchidism (3 cases). Interestingly, 91 patients were asymptomatic. Diaphragmatic plication was performed in all symptomatic patients (86 cases, 48.5%) and none had recurrence. CONCLUSIONS Clinical symptoms of CDE varied in severity, ranging from asymptomatic conditions to life-threatening respiratory distress. Timely accurate diagnosis and treatment of symptomatic CDE could effectively resolve respiratory morbidity and reduce complications. The diaphragm plication surgery provided good results among the study population with no recurrence.
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Affiliation(s)
- Shengde Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zang
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University
| | - Jin Zhu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pathology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxia Pan
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Wu
- Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing, CSTC2009CA5002; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders; Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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38
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Bochdalek hernia and repetitive pancreatitis in a 33 year old woman. Int J Surg Case Rep 2014; 5:743-5. [PMID: 25222941 PMCID: PMC4189077 DOI: 10.1016/j.ijscr.2014.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/08/2014] [Accepted: 08/16/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Bochdalek hernia presentation in adulthood is rare. The presentation in newborns is the most common, manifesting with data from respiratory failure secondary to pulmonary hypoplasia, requiring urgent surgical intervention with high morbidity and mortality. PRESENTATION OF CASE We present the case of a 33 year old woman admitted in the emergency room with severe abdominal pain in the left upper quadrant and disnea. After physical examination and laboratory test we diagnose mild acute pancreatitis. The patient haven't colelitiasis by ulstrasound or any risk factor for pancreatitis. Initially she received medical treatment and was discharged after one week. After four weeks she presented the same symptoms in two different occasions, with severe and mild pancreatitis respectively. A computed tomography report a left posterolateral diafragmatic hernia. In spite of the rare association of pancreatitis and Bochdalek hernia, we realized it as the etiology until the second event and planned his surgery. We made a posterolateral torachotomy and diafragmatic plasty with a politetrafluoroetileno mesh and after a 6 months follow up she has coursed asymptomatic. DISCUSSION The high rate of complications in this type of hernia requires us to perform surgical treatment as the hernia is detected. In this case it is prudent medical treatment prior to surgical correction despite this being the origin of the pancreatitis, because the systemic inflammatory response added by the surgical act could result in a higher rate of complications if not performed at the appropriate time. There is no precise rule to determine the type of approach of choice in this type of hernia which thoracotomy or laparotomy may be used. CONCLUSION Bochdalek hernia is a rare find in adults who require treatment immediately after diagnosis because of the high risk of complications. When presented with data from pancreatitis is recommended to complete the medical treatment of pancreatitis before surgery to obtain the best results, unless it exist another abdominal complication.
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Onuk Ö, Taş T, Şentürk AB, Sinanoğlu O, Balcı MBC, Çelik O, Nuhoğlu B. Right-sided Bochdalek hernia with intrathoracic ectopic kidney in an advanced-age adult: a case report. Urol Int 2014; 93:368-70. [PMID: 24642649 DOI: 10.1159/000353100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Abstract
Ectopic intrathoracic kidney is an extremely rare congenital anomaly and it is often asymptomatic and discovered incidentally on chest radiography. Although congenital thoracic kidney is mostly seen in infants, it can be diagnosed in neonatal age and adults as well. Herein, we present a 72-year-old woman who had a right-sided Bochdalek hernia with intrathoracic ectopic kidney. In contrast to the usually young patients with thoracic hernia, the presented case was the oldest female patient having thoracic kidney accompanied with Bochdalek hernia with clinical symptoms among those reported in the literature.
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Affiliation(s)
- Ö Onuk
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
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40
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Laparoscopic repair of combined right diaphragm and liver injuries with a sharp object: a case report. Case Rep Surg 2014; 2013:209494. [PMID: 24386586 PMCID: PMC3872161 DOI: 10.1155/2013/209494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 11/19/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction. Diaphragm injuries develop following penetrating or blunt traumas. The purpose of the case report is to present a 28 year old male patient with stable hemodynamic findings treated with laparoscopic approach following a liver injury combined with a right diaphragm injury caused by a sharp penetrating object. Case. 4 cm long transverse laceration was observed near the middle axillary line in the 6th right intercostal space in the examination performed on a 28 year old male patient who applied to the emergency service due to sharp penetrating object injury. Respiratory sounds were decreased in the right side and the examination revealed sensitivity in the abdomen. Elevation in the right diaphragm and hemopneumothorax was monitored in chest X-ray and computerized tomography. Closed subaqueous thorax drain was placed and the patient was taken to the surgery with a right diaphragm injury prediagnosis. Laparoscopic exploration was performed to the patient with stable hemodynamic findings by entering through 10 mm port above the abdomen. 6 cm long injury at the right side of diaphragm and approximately 2 cm deep at the deepest point and 5 cm long linear laceration was observed in the 7th segment of the liver. The diaphragm was repaired laparoscopically with sutures that do not melt on their own. Tampon was applied to the laceration in the liver and bleeding control was performed with suture. Patient was discharged on the 3rd day because he had no problems during postoperative follow-ups. Result. No noticed right side diaphragm rupture and possible concomitant visceral organ injuries following a penetrant injury that can cause significant mortality and morbidity should be definitely kept in mind. The detection of right side diaphragm and liver injury is vital with high mortality in case of delayed diagnosis, and direct radiography and computerized tomography are helpful in the diagnosis. Surgical treatment with laparoscopic approach is a method that leads to less hospitalization duration and less pain in cases that are hemodynamically stable.
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42
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Grisez B, Arbefeville E, Adams VI. Laceration of the Diaphragm: An Autopsy Series. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the surgical literature, laceration of the diaphragm is reported three times more often on the left side than the right, and bilateral lacerations are uncommon. However, in reported autopsy series, right, left, and bilateral lacerations occur at approximately equal frequencies. Few reports mention lacerations of the diaphragmatic crura. This retrospective case series describes the spectrum of autopsy findings in subjects with diaphragmatic lacerations and includes lacerations of the crura. Methods Records were reviewed from a consecutive series of 145 autopsies on subjects who died in traffic accidents or falls or leaps from a great height. The diagnostic standard was direct observation at autopsy. Results Twenty-two subjects had laceration of the diaphragm. Of these, four had a right leaf laceration, five had left leaf laceration, five had bilateral leaf lacerations, and nine had crural lacerations. Eight subjects with leaf lacerations also had herniations of viscera through the laceration. The lacerations ranged in length from 4 to 20 cm. All subjects sustained additional trauma to the torso. Nineteen of 22 subjects died of severe central nervous system trauma, cardiac or aortic trauma, or both. Conclusions Lacerations of the diaphragmatic crura are more common than previously reported. The incidence of right, left, and bilateral leaf lacerations is similar to that reported in other autopsy series. Lacerations of the diaphragm are associated with severe trauma of the central nervous system, heart, and aorta.
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Affiliation(s)
- Brian Grisez
- West Virginia University - School of Medicine, Morgantown, WV (BG), University of South Florida - Department of Pathology and Cell Biology, and Hillsborough County - Medical Examiner Department, Tampa, FL (EA)
| | - Elise Arbefeville
- West Virginia University - School of Medicine, Morgantown, WV (BG), University of South Florida - Department of Pathology and Cell Biology, and Hillsborough County - Medical Examiner Department, Tampa, FL (EA)
| | - Vernard I. Adams
- West Virginia University, Morgantown, WV
- West Virginia University - School of Medicine, Morgantown, WV (BG), University of South Florida - Department of Pathology and Cell Biology, and Hillsborough County - Medical Examiner Department, Tampa, FL (EA)
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Kumar S, Kumar S, Bhaduri S, More S, Dikshit P. An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report. Int J Surg Case Rep 2013; 4:446-8. [PMID: 23548705 DOI: 10.1016/j.ijscr.2013.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Post traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding. PRESENTATION OF CASE A 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment. DISCUSSION Blunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation(1) resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations. CONCLUSION In a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.
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Affiliation(s)
- Shailesh Kumar
- Department of Gen Surgery, PGIMER & Dr. RML Hospital, New Delhi, India.
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Shigeta T, Sakamoto S, Kanazawa H, Fukuda A, Kakiuchi T, Karaki C, Uchida H, Matsuno N, Tanaka H, Kasahara M. Diaphragmatic hernia in infants following living donor liver transplantation: report of three cases and a review of the literature. Pediatr Transplant 2012; 16:496-500. [PMID: 22672688 DOI: 10.1111/j.1399-3046.2012.01722.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DH is a rare complication following LT. This report presents three cases of right-sided DH after LT using a left-sided graft. All of the patients were younger than one yr of age, and they were critically ill owing to their original disease, characterized by biliary atresia, progressive familiar intrahepatic cholestasis, and acute liver failure. DH occurred with sudden onset within three months after LT. All of the cases were promptly diagnosed and treated. A literature review of 24 cases of DH identified four factors associated with DH: left-sided graft, right-sided DH, relatively delayed onset of DH, and age-specific chief complaint. DH following LT should be considered as a potential surgical complication when a left-sided graft is used, especially in small infants with coagulopathy and malnutrition.
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Affiliation(s)
- Takanobu Shigeta
- Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
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Abstract
The diagnosis of blunt diaphragmatic rupture (BDR) is difficult and often missed, leaving many patients with this traumatic injury at risk for life-threatening complications. The potential diagnostic pitfalls are numerous and include anatomic variants and congenital and acquired abnormalities. Chest radiography, despite its known limitations, may still be helpful in the early assessment of severe thoracoabdominal trauma and for detecting initially overlooked BDR or late complications of BDR. However, since the development of helical and multidetector scanners, computed tomography (CT) has become the reference standard; thus, knowledge of the CT signs suggestive of BDR is important for recognition of this injury pattern. A large number of CT signs of BDR have been described elsewhere, many of them individually, but the use of various appellations for the same sign can make previously published reports confusing. The systematic description and classification of CT signs provided in this article may help clarify matters and provide clues for diagnosing BDR. The authors describe 19 distinct CT signs grouped in three categories: direct signs of rupture, indirect signs that are consequences of rupture, and signs that are of uncertain origin. Since no single CT sign can be considered a marker leading to a correct diagnosis in every case of BDR, accurate diagnosis depends on the analysis of all signs present.
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Affiliation(s)
- Amandine Desir
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Sesia SB, Haecker FM. Late-presenting diaphragmatic hernia associated with intrathoracic kidney: tachypnoea as unique clinical sign. BMJ Case Rep 2012; 2012:bcr.08.2011.4638. [PMID: 22604763 DOI: 10.1136/bcr.08.2011.4638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intrathoracic renal ectopia associated with a congenital diaphragmatic hernia represents a very rare congenital malformation. The incidence of intrathoracic renal ectopia with congenital diaphragmatic hernia is reported to be less than 0.25%. The authors report on a 5-month-old female infant with late-presenting congenital diaphragmatic hernia associated with a left-sided intrathoracic ectopic kidney and adrenal gland. While prenatal ultrasound showed no pathology, the postnatal ultrasound assumed a left-sided renal agenesia. After recurrent episodes of tachypnoea, a chest x-ray confirmed the diagnosis of congenital diaphragmatic hernia which was repaired without complications. Intraoperatively, intrathoracic ectopic kidney was diagnosed. The authors discuss embryogenesis, the diagnostic algorithm and therapy as well as follow-up of this rare malformation.
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Affiliation(s)
- Sergio B Sesia
- Pediatric Surgery Department, University Children's Hospital Basel, Basel, Switzerland.
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47
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Sandstrom CK, Stern EJ. Diaphragmatic hernias: a spectrum of radiographic appearances. Curr Probl Diagn Radiol 2011; 40:95-115. [PMID: 21440192 DOI: 10.1067/j.cpradiol.2009.11.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diaphragmatic hernias are common, and although frequently incidental, recognition of both benign and life-threatening manifestations of diaphragmatic hernias is necessary to guide appropriate management. Congenital fetal diaphragmatic hernias, traumatic diaphragmatic rupture, and large symptomatic Bochdalek, Morgagni, and hiatal hernias are typically repaired surgically, while eventration, diaphragmatic slips, and small diaphragmatic hernias do not require intervention or imaging follow-up but should be recognized to avoid confusion with other diagnoses that require additional attention. This pictorial essay will explore the imaging findings and clinical characteristics of these entities.
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Affiliation(s)
- Claire K Sandstrom
- Division of Chest Imaging, Department of Radiology, University of Washington, Seattle, WA 98195-7115, USA.
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Abstract
Knowledge of the anatomy of the mediastinal nerves is essential for the evaluation and surgical treatment of most thoracic neoplasms. Thorough knowledge of the normal anatomy of the mediastinal nerves and of their variants cannot be overestimated because nerve trauma during nerve anatomy is also important because mediastinal or lung tumors can locally infiltrate those nerves either directly or through nodal metastases, making them generally unresectable.
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Affiliation(s)
- Jingyi Wang
- Heilongjian Provincial Hospital, Haerbin, 250036 People's Republic of China
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49
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Abstract
The thoracic diaphragm is a dome-shaped septum, composed of muscle surrounding a central tendon, which separates the thoracic and abdominal cavities. The function of the diaphragm is to expand the chest cavity during inspiration and to promote occlusion of the gastroesophageal junction. This article provides an overview of the normal anatomy of the diaphragm.
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Qiu Y, Zhu F, Wang B, Zhu Z, Yu Y, Sun X, Ma W. Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:266-73. [PMID: 21181213 PMCID: PMC3030707 DOI: 10.1007/s00586-010-1654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 10/20/2010] [Accepted: 12/05/2010] [Indexed: 11/26/2022]
Abstract
The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical invasion as well as achieve similar clinical outcomes compared with classical anterior approach.
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Affiliation(s)
- Yong Qiu
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Feng Zhu
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Bin Wang
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Zezhang Zhu
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Yang Yu
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Xu Sun
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
| | - Weiwei Ma
- The Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China
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