TITLE

Delayed presentation of congenital diaphragmatic hernia

AUTHOR(S)
Elhalaby, Essam A.; Abo Sikeena, Magda H.
PUB. DATE
July 2002
SOURCE
Pediatric Surgery International;Jul2002, Vol. 18 Issue 5/6, p480
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
The late-presenting congenital diaphragmatic hernia (CDH) represents a considerable diagnostic challenge. This study was undertaken to define various patterns of delayed presentation and to analyze pitfalls in the diagnosis and treatment of these patients. Thirty-three children with CDH were treated between 1993 and 2000; 15 of these (45.5%) who were diagnosed after the age of 2 months–14 years, median of 2.5 years are reported. Thirteen had a Bochdalek hernia and 2 had a Morgagni hernia. The diaphragmatic defect was right-sided in 6 cases and left-sided in 9. Five patients presented acutely, 3 with respiratory distress and 2 with gastrointestinal (GI) obstruction. The remaining 10 presented with chronic respiratory or GI complaints. Inappropriate insertion of a chest drain occurred in 3 patients misdiagnosed as having pleural effusion (2) and a pneumothorax (1). Two patients had previous chest radiographs reported normal. Plain radiographs were sufficient to make a definitive diagnosis in only 6 patients; GI contrast studies were necessary in the other 9. All patients were treated through an abdominal approach with primary closure of the diaphragmatic defect without a patch. A distinct hernia sac was present in 6 cases, and associated malrotation in 6. All except 1 patient survived the operation with rapid improvement of their GI and respiratory symptoms. We conclude that: (1) late-presenting CDH should be included in the differential diagnosis of any child with persistent GI or respiratory problems associated with an abnormal chest X-ray film; (2) nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected; and (3) GI contrast studies should be a part of the diagnostic work-up of these patients.
ACCESSION #
16127020

 

Related Articles

  • Pleural effusion requiring drainage in congenital diaphragmatic hernia: incidence, aetiology and treatment. Casaccia, G.; Crescenzi, F.; Palamides, S.; Catalano, O.; Bagolan, P.; Catalano, O A // Pediatric Surgery International;Jul2006, Vol. 22 Issue 7, p585 

    In congenital diaphragmatic hernia (CDH), chest tube insertion at repair could determine rapid overexpansion of hypoplastic lungs, increasing the risk of pneumothorax. Therefore, in our institution no drainage tube at CDH repair was inserted after 1997. Afterwards several patients needed chest...

  • Pleural effusion presenting as mediastinal widening. Mohapatra, Prasanta R.; Garg, Kranti; Prashanth, Chikkahonnaiah; Lahoria, Rupali // Lung India;Oct-Dec2013, Vol. 30 Issue 4, p354 

    We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported.

  • Is the pleural fluid transudate or exudate? A revisit of the diagnostic criteria. Joseph, J.; Badrinath, P.; Basran, G. S.; Sahn, S. A. // Thorax;Nov2001, Vol. 56 Issue 11, p867 

    Background: Pleural effusions are classified into transudates and exudates based on criteria developed in the 1970s. However, their accuracy has not been evaluated. We compared the performance of the pleural fluid absolute lactic dehydrogenase level (FLDH), fluid to serum ratio of...

  • Pleural effusion: a structured approach to care†The authors have no potential conflicts of interest. Rahman, Najib M.; Chapman, Stephen J.; Davies, Robert J. O. // British Medical Bulletin;Jan2005, Vol. 72 Issue 1, p31 

    The accumulation of fluid in the pleural space is a common manifestation of a wide range of disease. This review provides a structured approach to the investigation of the patient with a pleural effusion. This should allow an accurate diagnosis to be made with the minimum number of invasive and...

  • Pleural Effusions: Stability of Samples for White Blood Cell and Differential Counts. Celia Garlipp; Paula Bottini; Maria Souza; Deize Silva; Cassiana Denardi; Marco Moda // Laboratory Medicine;Nov2007, Vol. 38 Issue 11, p685 

    Background: Generally, the pleural fluid specimen should arrive promptly in the laboratory and be analyzed as soon as possible, and its preservation has always been a major problem. In this study, the authors evaluated the stability of pleural fluid samples for white blood cell (WBC) and...

  • Diagnostic Work-Up of Pleural Effusions. Froudarakis, Marios E. // Respiration;2008, Vol. 75 Issue 1, p4 

    A wide range of diseases may be the cause of an accumulation of fluid in the pleural space. Pleural effusion is a major diagnostic problem, since the pleura is an inner cavity with no direct access. The aim of this review is to provide a practical approach to the investigation of the patient...

  • Ruptured giant intrathoracic lipoblastoma in a 4-month-old infant: CT and MR findings. Park, C. H.; Kim, K. -I.; Lim, Y. T.; Chung, S. W.; Lee, C. H. // Pediatric Radiology;Jan2000, Vol. 30 Issue 1, p38 

    Background. We describe a 4-month-old infant with a ruptured intrathoracic lipoblastoma arising from the parietal pleura and associated with a pleural effusion.¶Objective. The clinical presentation was rapidly evolving respiratory distress. The chest radiograph showed a large mass and a...

  • Acute mediastinitis: spectrum of computed tomography findings. Exarhos, D.; Malagari, K.; Tsatalou, E.; Benakis, S.; Peppas, C.; Kotanidou, A.; Chondros, D.; Roussos, C.; Exarhos, D N; Tsatalou, E G; Benakis, S V // European Radiology;Aug2005, Vol. 15 Issue 8, p1569 

    The objective of this study was to describe CT findings and to determine the diagnostic value of CT in diagnosis of acute mediastinitis. CT findings were retrospectively studied in 40 patients with suspected acute mediastinitis, including 28 postoperative patients, five with acute descending...

  • Pleural Effusion: Beta-Trace Protein in Diagnosing Ventriculoperitoneal Shunt Complications. Born, Mark; Reichling, Stefanie; Schirmeister, Jörg // Journal of Child Neurology;Jul2008, Vol. 23 Issue 7, p810 

    Catheter dysfunction is a common complication with ventriculoperitoneal shunts. Apart from infection, obstruction, and leakage, migration of the shunt tip may cause particular problems. Pleural effusion is easily classified as a shunt complication if a transdiaphragmatic migration of a shunt can...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics