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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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Hebbale R, Ramachandran K, R V, Cherukumudi A. Congenital unilateral diaphragmatic eventration in adults – a case series with a brief literature review. HEART, VESSELS AND TRANSPLANTATION 2022. [DOI: 10.24969/hvt.2022.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: The aim of this article was to present the results of thoracotomy performed in three symptomatic adult patients with congenital diaphragm eventration in the light of current literature data.
Methods: Along with representation of the surgical management of each case, a brief review of literature was performed.
Results and Conclusion: Diaphragmatic eventration is a rare clinical entity that may be congenital or acquired. Surgery, which may be open or endoscopic, is the primary treatment modality for symptomatic patients.
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Sallout B, Alshebli D, Sallout L, Al Baqawi B, Faden MS. Fetal Diaphragmatic Eventration: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:993-997. [PMID: 33412306 DOI: 10.1016/j.jogc.2020.12.014] [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: 08/12/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Congenital diaphragmatic eventration (CDE) is a rare congenital malformation that is well described in the pediatric literature. In contrast to congenital diaphragmatic hernia (CDH), there is no physical defect in the diaphragm with CDE. Prenatal differentiation of the two pathologies represents a diagnostic and prognostic challenge. CASE A 26-year-old nulliparous woman was evaluated for a fetal thoracic mass. At 22 weeks, detailed morphology ultrasound revealed a multi-cystic structure in the left side of the thorax. Differential diagnosis included cystic congenital adenomatoid pulmonary malformation and CDH. Left diaphragmatic eventration was added to the differential diagnosis when serial ultrasound at 36 weeks showed the left hemidiaphragm as a thin membrane bulging into the fetal chest with the left kidney in a higher position underneath. The male infant was delivered vaginally at 373 weeks. CT imaging at 2 days of life showed findings consistent with left diaphragmatic eventration with protrusion of small bowel loops and the left kidney underneath. The infant was successfully extubated 3 days later and remained on nasal cannula until discharge on day 17 of life. At 6 months, the infant required operative repair owing to increasing shortness of breath. CONCLUSION CDE is a rare and difficult diagnosis to consider prenatally. Probable associated features may aid diagnosis. Additional, larger case series are needed to improve prenatal differentiation of this condition.
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Affiliation(s)
- Bahauddin Sallout
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Danya Alshebli
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Luai Sallout
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Badi Al Baqawi
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia
| | - Majed S Faden
- Maternal Fetal Medicine Department, King Fahad Medical City, Women's Specialized Hospital, Riyadh, Saudi Arabia.
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Zhao S, Pan Z, Li Y, An Y, Zhao L, Jin X, Fu J, Wu C. Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution. BMC Surg 2020; 20:270. [PMID: 33148241 PMCID: PMC7640684 DOI: 10.1186/s12893-020-00928-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. METHODS We retrospectively analyzed the clinical data of 125 children with CDE (90 boys, 35 girls; median age: 12.2 months, range: 1 h-7 years; body weight: 1.99-28.5 kg, median body weight: 7.87 ± 4.40 kg) admitted to our hospital in the previous 10 years, and we statistically analyzed their clinical manifestations and surgical methods. RESULTS A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). CONCLUSIONS The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery. Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.
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Affiliation(s)
- Shengliang Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Yong An
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China.,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China
| | - Lu Zhao
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Xin Jin
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Jian Fu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China
| | - Chun Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), Chongqing, 400014, People's Republic of China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, People's Republic of China. .,Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China. .,, Room 806, Kejiao Building (NO. 6 Building), No. 136, 2nd Zhongshan Road, Yuzhong District, Chongqing, China.
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Inoue S, Odaka A, Muta Y, Takeuchi Y, Yamashita T, Kabe K, Sakurai Y. Left hemidiaphragmatic elevation: Value of histology. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Thoracic versus abdominal approach to correct diaphragmatic eventration in children. J Pediatr Surg 2020; 55:245-248. [PMID: 31761454 DOI: 10.1016/j.jpedsurg.2019.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Plication of diaphragm (DP) for eventration (DE) can be done using thoracic or abdominal approaches. The purpose of our study was to compare outcomes between these approaches based on our experience and on systematic literature review. METHODS Retrospective records of children <16 years who underwent DP (single-center, 2004-2018) were recorded and analyzed. Systematic review and meta-analysis of related studies was undertaken. Data are reported as median (range). RESULTS Eighty-nine cases were identified in thoracic (Congenital = 5, Acquired = 84) and 13 (Congenital = 10, Acquired = 3) in abdominal group aged 5.88 (0.36-184.44) and 10.0 (0.12-181.8) months. Improvement in diaphragm level post-DP was significantly higher in abdominal [2(0-4)] than chest [1.5(0-5)] group (p = 0.04). On Cox regression analysis, there was a non-significant trend to a longer time to extubation in the chest group (Hazard ratio (HR) = 0.539[0.208-1.395], p = 0.203). Patients operated transthoracically left intensive care unit after a significantly longer time (HR = 0.339[0.119-0.966], p = 0.043). Patients operated transabdominally tended to be fed later, although this was not significant (HR = 1.801[0.762-4.253], p = 0.043). On Kaplan-Meier analysis, there was a non-significant trend to a lower rate of recurrence in the abdominal group (HR = 0.3196[0.061-1.675], p = 0.1876). In the meta-analysis including three published studies as well as our data (total n = 181, Thoracic = 139, Abdominal = 42), no difference was found in the incidence of recurrence amongst the 2 groups (RD = -0.04, 95%CI = -0.25, 0.18, p = 0.74). CONCLUSION This is one of the largest reports on outcomes of children undergoing DP for DE. There is no significant difference in recurrence rate, even though all recurrences in our series (15.7%) were in the acquired cases operated using a thoracic approach. TYPE OF STUDY Treatment Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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7
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Heiwegen K, van Heijst AFJ, Daniels-Scharbatke H, van Peperstraten MCP, de Blaauw I, Botden SMBI. Congenital diaphragmatic eventration and hernia sac compared to CDH with true defects: a retrospective cohort study. Eur J Pediatr 2020; 179:855-863. [PMID: 31965300 PMCID: PMC7220865 DOI: 10.1007/s00431-020-03576-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
Congenital diaphragmatic eventration (CDE) and congenital diaphragmatic hernia (CDH) with or without hernia sac are three different types of congenital diaphragmatic malformations, which this study evaluates. All surgically treated patients with CDE or Bochdalek type CDH between 2000 and 2016 were included in this retrospective analysis. Demographics, CDH-characteristics, treatment, and clinical outcome were evaluated. In total, 200 patients were included. Patients with an eventration or hernia sac had no significant differences and were compared as patients without a true defect to patients with a true defect. The 1-year survival of patients with a true defect was significantly lower than patients with no true defect (76% versus 97%, p = 0.001). CDH with no true defect had significantly better short-term outcomes than CDH with true defect requiring patch repair. However, at 30 days, they more often required oxygen supplementation (46% versus 26%, p = 0.03) and had a higher recurrence rate (8% versus 0%, p = 0.006) (three eventration and two hernia sac patients). Conclusion: Patients without a true defect seem to have a more similar clinical outcome than CDH patients with a true defect, with a better survival. However, the recurrence rate and duration of oxygen supplementation at 30 days are higher than CDH patients with a true defect.What is Known:• Congenital diaphragmatic hernia with or without hernia sac and congenital diaphragmatic eventration (incomplete muscularization) are often treated similarly.• Patients with hernia sac and eventration are thought to have a relatively good outcome, but exact numbers are not described.What is New:• Congenital diaphragmatic eventration and patients with hernia sac seem to have a more similar clinical outcome than Bochdalek type CDH with a true defect.• Patients without a true defect (eventration or hernia sac) have a high recurrence rate.
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Affiliation(s)
- Kim Heiwegen
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Arno FJ van Heijst
- Department of Neonatology, Radboudumc-Amalia Children’s Hospital, Nijmegen, Netherlands
| | - Horst Daniels-Scharbatke
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Michelle CP van Peperstraten
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Ivo de Blaauw
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
| | - Sanne MBI Botden
- Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children’s Hospital, Route 618, PO box 9101, 6500 Nijmegen, HB Netherlands
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Zhen L, Gu CM, Huang LY, Li DZ. Congenital Cystic Diaphragm with Diaphragmatic Eventration in a Fetus: A Case Presentation. Fetal Pediatr Pathol 2019; 38:335-339. [PMID: 30912683 DOI: 10.1080/15513815.2019.1588440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Congenital diaphragmatic eventration (CDE) is defined as the abnormal elevation of the diaphragm, due to incomplete muscularization of the diaphragm with a thin membranous sheet replacing normal diaphragmatic muscle. Case report: We report a prenatal case with a diaphragmatic mesothelial cyst combined with CDE. Conclusion: A large cystic mass between the thoracic wall and the liver in early pregnancy is highly suggestive of cystic diaphragm.
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Affiliation(s)
- Li Zhen
- a Guangzhou Women and Children's Medical Center , Guangzhou , China
| | - Cong-Min Gu
- a Guangzhou Women and Children's Medical Center , Guangzhou , China
| | - Lv-Yin Huang
- a Guangzhou Women and Children's Medical Center , Guangzhou , China
| | - Dong-Zhi Li
- a Guangzhou Women and Children's Medical Center , Guangzhou , China
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Lameh A, Seyedi SJ, Farrokh D, Lavasani S, Alamdaran SA. Diagnostic Value of Ultrasound in Detecting Causes of Pediatric Chest X-Ray Opacity. Turk Thorac J 2019; 20:175-181. [PMID: 30986176 PMCID: PMC6590271 DOI: 10.5152/turkthoracj.2018.18087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/18/2018] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Computed tomography is considered as the diagnostic gold standard for following up the majority of pediatric chest X-ray (CXR) opacities. However, radiation, cost, and waiting times have led to search for diagnostic alternatives. This study was conducted to determine the diagnostic accuracy of the ultrasound (US) in detecting the causes of pediatric CXR opacities. MATERIALS AND METHODS This study was conducted on the pediatric patients with CXR opacity referring to Dr. Sheikh Hospital in Mashhad, Iran during 2016-2017. After undergoing the US exam, the patients were followed to obtain the final diagnosis based on reference standard (RF). The accuracy of the US was calculated in detection of thoracic lesions. P value <0.05 was considered to be significant. RESULTS The most common diagnostic cause of CXR opacity based on RF was pneumonia (n=46, 35-38%), thymus (n=37, 28-46%), bone and soft tissue mass (n=12, 9.23%), cystic lesions (n=11, 8.46%), and diaphragmatic lesions (n=10, 7.69%), as well as intrathoracic masses and empyema (n=7, 5.38%). In only four patients (3.07%), the final diagnosis based on RF was inconsistent with the US diagnosis. The diagnostic accuracy of the US was 100% in the diagnosis of bone and soft tissue masses, diaphragmatic lesions, empyema, and normal thymus, and the accuracy was 96.92% for pneumonia, and 99.23% for cystic lesions and intrathoracic masses. CONCLUSION Regarding the assessed diagnostic accuracy, the US can be a reliable diagnostic tool to differentiate the main cause of pediatric CXR opacity.
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Affiliation(s)
- Ahmadreza Lameh
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Seyed Javad Seyedi
- Department of Pediatrics, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Donia Farrokh
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
| | - Somayehsadat Lavasani
- Department of Oral and Maxillofacial Radiology, Birjand University of Medical Sciences, School of Medicine, Birjand, Iran
| | - Seyed Ali Alamdaran
- Department of Radiology, Mashhad University of Medical Sciences, School of Medicine, Mashhad, Iran
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10
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Unolt M, DiCairano L, Schlechtweg K, Barry J, Howell L, Kasperski S, Nance M, Adzick NS, Zackai EH, McDonald-McGinn DM. Congenital diaphragmatic hernia in 22q11.2 deletion syndrome. Am J Med Genet A 2016; 173:135-142. [PMID: 27682988 DOI: 10.1002/ajmg.a.37980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/29/2016] [Indexed: 11/10/2022]
Abstract
We report the important association of congenital diaphragmatic hernia (CDH) and 22q11.2 deletion syndrome (22q11.2DS). The prevalence of CDH in our cohort of patients with 22q11.2DS is 0.8% (10/1246), which is greater than in the general population (0.025%). This observation suggests that 22q11.2DS should be considered when a child or fetus presents with CDH, in particular when other clinical findings associated with the 22q11.2DS are present, such as congenital cardiac defects. Furthermore, this finding may lead to the identification of an additional locus for diaphragmatic hernia in the general population. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marta Unolt
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics and Pediatric Neuropsychiatry, "Sapienza" University of Rome, Philadelphia, Pennsylvania
| | - Lauren DiCairano
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kathryn Schlechtweg
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica Barry
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lori Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stefanie Kasperski
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael Nance
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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11
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Sun J, McGillivray AJ, Pinner J, Yan Z, Liu F, Bratkovic D, Thompson E, Wei X, Jiang H, Asan, Chopra M. Diaphragmatic Eventration in Sisters with Asparagine Synthetase Deficiency: A Novel Homozygous ASNS Mutation and Expanded Phenotype. JIMD Rep 2016; 34:1-9. [PMID: 27469131 DOI: 10.1007/8904_2016_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asparagine Synthetase Deficiency (ASNSD; OMIM #615574) is a newly described rare autosomal recessive neurometabolic disorder, characterised by congenital microcephaly, severe psychomotor delay, encephalopathy and progressive cerebral atrophy. To date, seven families and seven missense mutations in the ASNSD disease causing gene, ASNS, have been published. METHODS We report two further affected infant sisters from a consanguineous Indian family, who in addition to the previously described features had diaphragmatic eventration. Both girls died within the first 6 months of life. Whole exome sequencing (WES) was performed for both sisters to identify the pathogenic mutation. The clinical and biochemical parameters of our patient are compared to previous reports. RESULTS WES demonstrated a homozygous novel missense ASNS mutation, c.1019G > A, resulting in substitution of the highly conserved arginine residue by histidine (R340H). CONCLUSION This report expands the phenotypic and mutation spectrum of ASNSD, which should be considered in neonates with congenital microcephaly, seizures and profound neurodevelopmental delay. The presence of diaphragmatic eventration suggests extracranial involvement of the central nervous system in a disorder that was previously thought to exclusively affect the brain. Like all previously reported patients, these cases were diagnosed with WES, highlighting the clinical utility of next generation sequencing in the diagnosis of rare, difficult to recognise disorders.
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Affiliation(s)
- Jun Sun
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Angela J McGillivray
- Department of Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia
| | - Jason Pinner
- Department of Medical Genomics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia
| | - Zhihui Yan
- Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - Fengxia Liu
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Drago Bratkovic
- Metabolic Clinic, South Australian Clinical Genetics Service, SA Pathology, 5000, Adelaide, SA, Australia
| | - Elizabeth Thompson
- Department of Radiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, 2050, NSW, Australia
| | - Xiuxiu Wei
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China.,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China.,BGI-Shenzhen, Shenzhen, 518083, China
| | - Huifeng Jiang
- Key Laboratory of Systems Microbial Biotechnology, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - Asan
- Binhai Genomics Institute, BGI-Tianjin, BGI-Shenzhen, Tianjin, 300308, China. .,Tianjin Enterprise Key Laboratory of Clinical molecular diagnostic, BGI-Shenzhen, Tianjin, 300308, China. .,BGI-Shenzhen, Shenzhen, 518083, China.
| | - Maya Chopra
- Department of Medical Genomics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, Sydney, NSW, Australia. .,Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. .,Discipline of Genetic Medicine, University of Sydney, Sydney, 2050, NSW, Australia.
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12
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Alshorbagy A, Mubarak Y. Open Transthoracic Plication of the Diaphragm for Unilateral Diaphragmatic Eventration in Infants and Children. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:307-10. [PMID: 26509123 PMCID: PMC4622030 DOI: 10.5090/kjtcs.2015.48.5.307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
Background To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.
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Affiliation(s)
| | - Yasser Mubarak
- Cardiothoracic Surgery Department, Minia University Hospital
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13
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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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14
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Spaggiari E, Stirnemann J, Bernard JP, De Saint Blanquat L, Beaudoin S, Ville Y. Prognostic value of a hernia sac in congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:286-290. [PMID: 22605546 DOI: 10.1002/uog.11189] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH). METHODS Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality. RESULTS Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac (P = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly. CONCLUSION The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH.
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker Enfants-Malades, AP-HP and Université Paris Descartes, Paris, France
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15
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Abstract
Congenital diaphragmatic eventration is a common condition in infancy but is a rare anomaly in an adult. The muscle is permanently elevated, but keeps its continuity and attachments to the costal margins, which differentiates diaphragmatic eventration from diaphragmatic hernia. We describe a case of congenital eventration of the left diaphragm in a 35-year-old male who underwent successful surgical repair.
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
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16
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Takahashi T, Okazaki T, Ochi T, Nishimura K, Lane GJ, Inada E, Yamataka A. Thoracoscopic plication for diaphragmatic eventration in a neonate. Ann Thorac Cardiovasc Surg 2012; 19:243-6. [PMID: 22971706 DOI: 10.5761/atcs.cr.12.01907] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Currently, thoracoscopic surgery is replacing thoracotomy for an ever increasing number of indications, even in pediatric surgery. However, there are few reports describing thoracoscopic plication (TP) for diaphragmatic eventration in children, particularly in neonates. We report a case of TP under single-lung ventilation in a neonate with diaphragmatic eventration. CASE REPORT A 10-day-old boy was referred for surgical management of right diaphragmatic eventration. Birth was at term, following an uncomplicated pregnancy and delivery. Shortness of breath, labored respiration and chest retraction presented soon after birth, necessitating mechanical ventilation. Chest radiography and computed tomography revealed an elevated right hemidiaphragm. Attempted weaning off mechanical ventilation failed with persistence of respiratory symptoms, requiring nasal directional positive airway pressure. However, because there was no resolution of symptoms, TP was performed using a 3 port technique under single-lung ventilation on day 17 of life. The postoperative course was excellent with complete resolution of respiratory symptoms with no recurrence for 9 months. CONCLUSION To the best of our knowledge, this is the youngest case of TP for diaphragmatic eventration performed under single-lung ventilation. TP is safe, effective and minimally invasive and should be considered actively for the treatment of symptomatic diaphragmatic eventration even in neonates.
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Affiliation(s)
- Tsubasa Takahashi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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17
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Coley BD. Chest Sonography in Children: Current Indications, Techniques, and Imaging Findings. Radiol Clin North Am 2011; 49:825-46. [DOI: 10.1016/j.rcl.2011.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Chaudhary K, Anand R, Girdhar KK, Manchanda G, Panda AK, Bhalotra AR. Anesthetic management of a patient with congenital diaphragmatic eventration. J Anesth 2011; 25:585-8. [PMID: 21626261 DOI: 10.1007/s00540-011-1171-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 05/07/2011] [Indexed: 11/29/2022]
Abstract
Congenital diaphragmatic eventration is uncommon in adults and is caused by paralysis, aplasia or atrophy of the muscular fibers of the diaphragm. It may cause severe dyspnea, orthopnea and hypoxia in adult patients. Most symptomatic patients may be managed efficiently without the need for surgical correction, although any event that leads to an increase in intra-abdominal pressure puts them at the risk of spontaneous diaphragmatic rupture. This case report presents the successful anesthetic management of an adult female with congenital diaphragmatic eventration undergoing diagnostic laparoscopy and hysteroscopy using a total intravenous anesthesia technique. Essential steps to prevent any rise in intrathoracic and intra-abdominal pressures along with care to minimize intragastric volume were taken.
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Affiliation(s)
- Kapil Chaudhary
- Department of Anesthesia, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
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19
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Sahinoglu Z, Yuksel A, Uludogan M, Bilgic R, Toksoy G. Left diaphragmatic eventration associated with ipsilateral pulmonary sequestration and intrathoracic kidney in a fetus: reviewing the prenatal diagnosis and etiopathogenesis. Fetal Pediatr Pathol 2011; 30:233-43. [PMID: 21434828 DOI: 10.3109/15513815.2011.555808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prenatal diagnosis of congenital diaphragmatic eventration, pulmonary extralobar sequestration and intrathoracic ectopic kidney in a single fetus is not reported yet according to the pubmed. Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm. Differential diagnosis from hernia is essential for the perinatal management. Extralobar sequestrations are usually asymptomatic and detected incidentally. Intrathoracic kidney is an extremely rare congenital anomaly. Genitourinary and cardiac anomalies should be searched as common co-existing malformations. Besides prenatal ultrasound, fetal magnetic resonance imaging has a substantial support in counselling the family, planning the follow-up of the pregnancy and decision-making for the perinatal management.
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Affiliation(s)
- Zeki Sahinoglu
- Department of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey.
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20
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Eventration with diaphragm perforation leading to secondary diaphragmatic hernia and intestinal strangulation. Hernia 2009; 14:531-3. [PMID: 19826894 DOI: 10.1007/s10029-009-0573-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 09/25/2009] [Indexed: 10/20/2022]
Abstract
We report a rare occurrence of a previously asymptomatic eventration that presented with intestinal obstruction followed by respiratory distress. The thinned out diaphragm had a nontraumatic perforation with herniation of the small bowel through the narrow defect. The herniated gut became strangulated and dilated inside the thorax, resulting in respiratory compromise. The rare occurrence of this vicious cycle of obstruction and respiratory failure leading to a sudden clinical deterioration in a previously stable patient is described.
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21
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Danhaive O, Lozzi S, D'amico A, Devito R, Boldrini R, Corchia C, Bagolan P, Bertini E. Neonatal-onset nemaline myopathy mimicking congenital diaphragmatic hernia. J Pediatr Surg 2007; 42:E19-22. [PMID: 17618867 DOI: 10.1016/j.jpedsurg.2007.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a newborn with severe respiratory failure and abnormal elevation of the right diaphragm, congenital diaphragmatic hernia with sac was diagnosed during surgery. However, microscopic examination of the sac showed atrophic striated muscle cells, indicating eventration instead of hernia. After several extubation failures, the final diagnosis of nemaline myopathy was made by skeletal muscle biopsy. In diaphragmatic defects with sac, diaphragm microscopic analysis should be recommended in order to discriminate between hernia and eventration. Congenital myopathies may underlie such diaphragmatic defects and should be promptly recognized, given their prognostic implications.
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Affiliation(s)
- Olivier Danhaive
- Laboratory of Neonatal Biology, Bambino Gesù Children's Hospital, 00165 Rome, Italy.
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22
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Pober BR. Overview of epidemiology, genetics, birth defects, and chromosome abnormalities associated with CDH. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2007; 145C:158-71. [PMID: 17436298 PMCID: PMC2891729 DOI: 10.1002/ajmg.c.30126] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a common and well-studied birth defect. The etiology of most cases remains unknown but increasing evidence points to genetic causation. The data supporting genetic etiologies which are detailed below include the association of CDH with recurring chromosome abnormalities, the existence of CDH-multiplex families, and the co-occurrence of CDH with additional congenital malformations.
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Affiliation(s)
- Barbara R Pober
- Department of Surgery, Children's Hospital of Boston, Boston, MA, USA.
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23
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Jeanty C, Nien JK, Espinoza J, Kusanovic JP, Gonçalves LF, Qureshi F, Jacques S, Lee W, Romero R. Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:378-87. [PMID: 17366518 PMCID: PMC2391071 DOI: 10.1002/uog.3958] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia. METHODS We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies). RESULTS A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02). CONCLUSIONS The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- C Jeanty
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD, USA
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24
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Zankl A, Osterheld MC, Vial Y, Beurret N, Meuli R, Meagher-Villemure K, Roth-Kleiner M. Right-sided diaphragmatic eventration: a rare cause of non-immune hydrops fetalis. Neonatology 2007; 92:14-8. [PMID: 17596732 DOI: 10.1159/000098412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/18/2006] [Indexed: 11/19/2022]
Abstract
We report 2 cases of non-immune hydrops fetalis (NIHF) in which autopsy findings revealed an association with right-sided congenital diaphragmatic eventration (CDE). Both patients born at 30 weeks of gestation presented with severe generalized skin oedema, pleural effusions and ascites. They both died shortly after birth of cardiorespiratory insufficiency due to lung hypoplasia and low output heart failure. The right thoracic cavity was filled with the membranous but intact right diaphragm covering the herniated visceral organs including parts of the liver, small bowel and colon surrounded by voluminous ascites. In similar fashion to the situation seen in congenital diaphragmatic hernia (CDH), the displaced visceral organs led to impaired lung growth resulting in important lung hypoplasia and obstructed venous return. Extravascular liquid accumulation was probably further aggravated by hypoproteinaemia secondary to liver dysfunction resulting from the venous congestion and cardiac failure. In summary, CDE is a rare condition resulting from impaired ingrowth of muscle fibres into the diaphragm during the first trimester. Prenatal differentiation of CDE from CDH is a real challenge. The association of CDE and NIHF has not been previously described.
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Affiliation(s)
- A Zankl
- Division of Neonatology, Department of Pediatrics, University Hospital of Lausanne, Lausanne, Switzerland
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25
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Jackson C, Collyer PB, Loynachan A. Congenital diaphragmatic eventration in a stillborn foal. J Vet Diagn Invest 2006; 18:412-5. [PMID: 16921887 DOI: 10.1177/104063870601800419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A stillborn full term foal was presented at necropsy. The dilated duodenum and the dorsal and ventral left colon and cecum extended into the thoracic cavity and were encased by a thin transparent membrane originating from the diaphragm. The congenital condition was diagnosed as a developmental anomaly with diaphragmatic eventration. To the authors' knowledge, this is the first report of diaphragmatic eventration in a Thoroughbred stillborn foal.
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Affiliation(s)
- Carney Jackson
- College of Agriculture, Livestock Disease Diagnostic Center, University of Kentucky, Lexington, KY 40512-4125, USA.
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26
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Abstract
OBJECTIVE Eventration of the diaphragm (ED) is defined as the abnormal elevation of the diaphragm. Although asymptomatic ED may be amenable to conservative treatment, symptomatic ED in children, either congenital or acquired, may require surgical treatment. This study evaluated the results of diaphragmatic plication in children with unilateral ED. METHODS Fifteen patients who had undergone diaphragmatic plication for ED between 1997 and 2003 were evaluated retrospectively. The diagnosis of ED was established by routine chest radiographs and fluoroscopy. Patients who failed to respond to nonoperative treatment were referred for surgery. Nine patients underwent diaphragmatic fluoroscopy 1-5 years following plication to assess function. RESULTS Indications for diaphragmatic plication were respiratory symptoms such as tachypnoea, dyspnoea, recurrent pneumonia and failure to thrive. In 14 patients, the position of the diaphragm was normal after plication, but the diaphragm was elevated without symptoms in one patient during postoperative follow-up. The motion of the diaphragm was investigated in nine patients. Fluoroscopic studies showed that the operated hemidiaphragm was immobile and there was no paradoxical motion. No return of symptoms was found during follow-up. CONCLUSION ED is the abnormal elevation of the diaphragm as a result of paralysis or aplasia of the muscular fibres. The abnormally elevated diaphragm may compress the ipsilateral lung, and with respiratory effort the mediastinum may shift towards the normal side. Therefore, diaphragmatic plication is performed to restore normal pulmonary parenchymal volume by replacing the diaphragm in its normal location. After plication, there was immediate remission of symptoms in most patients and decreasing symptoms were observed for a year in others. During follow-up, the location of the diaphragm was normal and no paradoxical movement was observed. Relapse of symptoms was not noted in patients with immobile diaphragms.
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Affiliation(s)
- Tugrul Tiryaki
- Pediatric Surgery Clinic, Social Security Institution Ankara Children's Hospital, Ankara, Turkey.
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27
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Becmeur F, Talon I, Schaarschmidt K, Philippe P, Moog R, Kauffmann I, Schultz A, Grandadam S, Toledano D. Thoracoscopic diaphragmatic eventration repair in children: about 10 cases. J Pediatr Surg 2005; 40:1712-5. [PMID: 16291157 DOI: 10.1016/j.jpedsurg.2005.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Recent reports in literature have emphasized the clinical perception of reduced pain, postoperative morbidity, and dysfunction associated with thoracoscopic approach compared with standard thoracotomy. The authors describe a thoracoscopic approach and technical details for diaphragmatic eventration repair in children. PATIENTS AND METHODS Ten patients, 4 girls and 6 boys, 1 teenager (14 years old) and 9 children (age range, 6-41 months; average, 17 months), were operated for a diaphragmatic eventration in 3 different pediatric surgery teams, according to the same technique. Symptoms were recurrent infection (7 cases), dyspnea on exertion (2 cases), and a rib deformity (1 case). An elective thoracoscopy was performed, patient in a lateral decubitus. A low carbon dioxide insufflation allowed a lung collapse. Reduction of the eventration was made progressively when folding and plicating the diaphragm. Plication of the diaphragm was done with an interrupted suture (6 cases) or a running suture (4 cases). The procedure finished either with an exsufflation (4 cases) or a drain (6 cases). RESULTS A conversion was necessary in 2 cases: 1 insufflation was not tolerated and 1 diaphragm, higher than the fifth space, reduced too much the operative field. Patients recovered between 2 and 4 days. Dyspnea disappeared immediately. Mean follow-up of 16 months could assess the clinical improvement in every patient. DISCUSSION Thoracoscopic conditions are quite different between a diaphragmatic hernia repair previously reported and an eventration. Concerning diaphragmatic hernias, reduction is easy, giving a large operative space for suturing the diaphragm. Concerning diaphragmatic eventrations, the lack of space remains important at the beginning of the procedure despite the insufflation into the pleural cavity. The operative ports must be high enough in the chest to allow a good mobility of the instruments. Chest drainage seems to be unnecessary. CONCLUSION Diaphragmatic eventration repair by thoracoscopy is feasible, safe, and efficient in children. Above all, it avoids a thoracotomy. It improves the immediate postoperative results with a good respiratory function.
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Affiliation(s)
- François Becmeur
- Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Hôpital de Hautepierre, 67098 Strasbourg, France.
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28
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Yang CK, Shih JC, Hsu WM, Peng SS, Shyu MK, Lee CN, Hsieh FJ. Isolated right diaphragmatic eventration mimicking congenital heart diseasein utero. Prenat Diagn 2005; 25:872-5. [PMID: 16193461 DOI: 10.1002/pd.1281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diaphragmatic eventration is the upward displacement of the abdominal viscera secondary to a thin or paralytic diaphragm. Its clinical presentations and radiographic pictures are similar to those of diaphragmatic hernia. Prenatal diagnosis of diaphragmatic eventration is extremely rare. A pregnant woman was referred to us because of abnormal cardiac findings noted at 20 weeks of gestation. A diagnosis of partial anomalous pulmonary venous connection was made on the basis of our findings of right atrial enlargement with an abnormal vascular channel drainage to it. The infant was born via cesarean section at 40 weeks and developed complications of cyanosis immediately after birth. Postnatal imaging studies and surgical findings disclosed right side diaphragmatic eventration with liver and associated vasculature upward displacement into the right pleural cavity. The cardiac structure was otherwise normal. We conclude that when an abnormal vessel tracing and unexplainable cardiac chamber asymmetry is encountered, diaphragmatic eventration should be considered as one of the differential diagnoses. Correct recognition and transferral to the hospital for neonatal assistance may lead to timely and appropriate management of these fetuses.
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Affiliation(s)
- C-K Yang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University Hospital, Taipei, Republic of China
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