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Alhamad M, Anand D. Congenital diaphragmatic hernia with associated broncho-pulmonary sequestration: A report of two cases and a literature review. J Neonatal Perinatal Med 2024; 17:123-131. [PMID: 38189715 DOI: 10.3233/npm-230042] [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: 01/09/2024]
Abstract
BACKGROUND Congenital Diaphragmatic Hernia (CDH) is a severe congenital anomaly with significant morbidity and mortality. It can be isolated or can be associated with other congenital anomalies, including broncho-pulmonary sequestration (BPS). The association of CDH with BPS (CDH+BPS) is uncommon but has been previously reported, and it can complicate the course of the disease in patients with CDH. We report two cases of CDH+BPS that were recently treated at our CDH-Qatar (CDH-Q) program. METHODS We reviewed CDH-Q program registry to search for CDH+BPS and extracted the data for the identified cases. We also reviewed the previously published literature available on PubMed for similar cases. RESULTS Out of 53 cases of CDH referred to CDH-Q from January 2018 to December 2022, two cases of CDH+BPS were identified, with an estimated prevalence of 3.8% of this association in our CDH population. Both cases were born at term. Case 1 was diagnosed with CDH+BPS postnatally, while case 2 was diagnosed with CDH antenatally but BPS was diagnosed after birth. Both cases underwent a surgical repair of the CDH with resection of the associated BPS, and the histopathology of the resected lung tissue confirmed the presence of BPS in both. Both cases survived to discharge. CONCLUSION The association of CDH+BPS is uncommon; however, it can have significant consequences on the management and the prognosis of patients with CDH. Reporting these cases is important to provide a better understanding of this association and its impact on CDH patients.
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Affiliation(s)
- Moath Alhamad
- Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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2
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Ruano R, Ibirogba ER, Wyatt MA, Balakrishnan K, Qureshi MY, Kolbe AB, Dearani JA, Boesch RP, Segura L, Arendt KW, Bendel-Stenzel E, Salik SS, Klinkner DB. Sequential Minimally Invasive Fetal Interventions for Two Life-Threatening Conditions: A Novel Approach. Fetal Diagn Ther 2020; 48:70-77. [PMID: 33080593 DOI: 10.1159/000510635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In utero interventions are performed in fetuses with "isolated" major congenital anomalies to improve neonatal outcomes and quality of life. Sequential in utero interventions to treat 2 anomalies in 1 fetus have not yet been described. CASE PRESENTATION Here, we report a fetus with a large left-sided intralobar bronchopulmonary sequestration (BPS) causing mediastinal shift, a small extralobar BPS, and concomitant severe left-sided congenital diaphragmatic hernia (CDH). At 26-week gestation, the BPS was noted to be increasing in size with a significant reduction in right lung volume and progression to fetal hydrops. The fetus underwent ultrasound-guided ablation of the BPS feeding vessel leading to complete tumor regression. However, lung development remained poor (O/E-LHR: 0.22) due to the left-sided CDH, prompting fetal endoscopic tracheal occlusion therapy at 28-week gestation to allow increased lung growth. After vaginal delivery, the newborn underwent diaphragmatic repair with resection of the extralobar sequestration. He was discharged home with tracheostomy on room air at 9 months. DISCUSSION/CONCLUSION Sequential in utero interventions to treat 2 severe major anomalies in the same fetus have not been previously described. This approach may be a useful alternative in select cases with otherwise high morbidity/mortality. Further studies are required to confirm our hypothesis.
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Affiliation(s)
- Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA, .,Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA,
| | - Eniola R Ibirogba
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michelle A Wyatt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - M Yasir Qureshi
- Department of Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Amy B Kolbe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - R Paul Boesch
- Division of Pediatric Pulmonology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Leal Segura
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ellen Bendel-Stenzel
- Division of Neonatology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Shana S Salik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Denise B Klinkner
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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3
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Postnatally diagnosed coexisting congenital diaphragmatic hernia with pulmonary sequestration: a report of two cases. Obstet Gynecol Sci 2020; 63:529-533. [PMID: 32689778 PMCID: PMC7393745 DOI: 10.5468/ogs.20052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022] Open
Abstract
While the associations between pulmonary sequestration (PS) and congenital diaphragmatic hernia (CDH) are known, CDH may be obscured by PS and thus, overlooked on prenatal ultrasonography when coexisting with PS. We present 2 cases of postnatally diagnosed CDH combined with PS. In both cases, PS was prenatally diagnosed as an isolated lung mass, while CDH was confirmed only after birth. Both newborns were sufficiently stable that management was not required immediately after birth. PS may function as an "anatomical barrier" to prevent herniation of the abdominal contents into the chest, thus acting as a "protector" providing normal lung maturation throughout pregnancy. If PS is suspected prenatally, coexisting CDH may be obscured; thus, close prenatal care and counseling of the parents regarding the possibility of CDH are essential. These infants should be delivered at a tertiary center, and imaging should be performed to exclude coexisting CDH.
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4
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Soni S, Moldenhauer JS, Rintoul N, Adzick NS, Hedrick HL, Khalek N. Perinatal Outcomes in Fetuses Prenatally Diagnosed with Congenital Diaphragmatic Hernia and Concomitant Lung Lesions: A 10-Year Review. Fetal Diagn Ther 2020; 47:630-635. [PMID: 32380499 DOI: 10.1159/000507481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022]
Abstract
AIM To describe perinatal outcomes of fetuses with a prenatal diagnosis of a concomitant lung lesion in the setting of congenital diaphragmatic hernia (CDH) and to compare outcomes with an isolated CDH control group without a lung lesion, matched by ultrasound-based prognostic markers including presence of liver herniation and lung measurements. MATERIAL AND METHODS This was a retrospective case-control study, wherein all pregnancies diagnosed with CDH and concomitant lung lesions were identified between July 1, 2008, and December 31, 2018. For each case, 2 controls with isolated CDH from the same study period were selected after matching for the presence of liver herniation into the thoracic cavity and ultrasound-based lung measurements either observed over expected lung-to-head ratio (LHR) or absolute LHR with their corresponding gestational age. The outcomes analyzed in the 2 groups included survival to hospital discharge, neonatal intensive care unit (NICU) length of stay (LOS), extracorporeal membrane oxygenation (ECMO) requirement and need for supplemental oxygen (O2) at day 30 of life. RESULTS A total of 21 pregnancies were identified with CDH and a concomitant lung lesion in the study period. All the lung lesions were stratified into a "low-risk category" with a congenital cystic adenomatoid malformation volume ratio of less than 1.0 at the time of presentation. None of these fetuses developed hydrops or required in utero intervention. Overall survival in the group was 80.7% (17/21) and rate of ECMO was 38.1%. Causes of mortality included pulmonary insufficiency, sepsis, renal failure, and bowel infarction. Upon comparison between the cases and controls, the 2 groups were similar with respect to pregnancy demographics. There were no fetal demises in either group. Outcomes including survival rate, NICU LOS, ECMO requirements and need for supplemental O2 at day 30 of life, were comparable among the 2 groups. CONCLUSIONS In our descriptive series, the presence of a concomitant, low-risk lung lesion in the setting of fetal CDH did not have a significant impact on the natural course of the disease, nor was it associated with a worse prognosis.
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Affiliation(s)
- Shelly Soni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA, .,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, .,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,
| | - Julie S Moldenhauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Natalie Rintoul
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N Scott Adzick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Holly L Hedrick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nahla Khalek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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5
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Lim D, Kostin R. Intralobar pulmonary sequestration associated with Bochdalek hernia: first reported case in an adult male and literature review. J Surg Case Rep 2018; 2018:rjy211. [PMID: 30135707 PMCID: PMC6097594 DOI: 10.1093/jscr/rjy211] [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: 06/05/2018] [Revised: 07/12/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022] Open
Abstract
Pulmonary sequestrations (PS) are rare congenital malformations that can be difficult to diagnose. PS have no connection with the bronchial tree and are vascularized through an aberrant artery mostly arising from descending thoracic or abdominal aorta. The standard diagnostic method is the computed tomography angiography and delayed diagnosis can lead to recurrent pneumonia and hemoptysis. Herein, we have a case of a patient with an intralobar sequestration associated with a Bochdalek hernia. The diagnosis was delayed in this case as with many other similar case reports because details of the patient’s history were overlooked.
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Affiliation(s)
- Daniel Lim
- General Surgery Department, UPMC Pinnacale Health, Harrisburg, PA, USA
| | - Raymond Kostin
- General Surgery Department, UPMC Pinnacale Health, Harrisburg, PA, USA
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6
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Lima M, Maffi M, Gargano T, Ruggeri G, Libri M, Destro F. Thoracoscopic Approach for Congenital Diaphragmatic Hernia: A Useful Tool in Diagnosis and Treatment of Unexpected Associated Lung Lesion. European J Pediatr Surg Rep 2016; 4:10-12. [PMID: 28018801 PMCID: PMC5177555 DOI: 10.1055/s-0036-1580705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/12/2016] [Indexed: 11/04/2022] Open
Abstract
We report the case of a neonate affected by prenatally diagnosed congenital diaphragmatic hernia (CDH), treated by thoracoscopy. During the procedure, we detected an associated extralobar pulmonary sequestration (EPS), which was preoperatively undiagnosed, and we removed it. EPS has been shown to be associated with CDH in up to 15 to 40% of cases. A possible explanation hypothesized is that pulmonary sequestration, which develops at 4 to 5 weeks of gestation, can disturb the fusion of the diaphragm and closure of the pleuroperitoneal canal. The thoracoscopic approach permitted us to identify the thoracic EPS that probably would have been otherwise missed.
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Affiliation(s)
- Mario Lima
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Michela Maffi
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Tommaso Gargano
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Ruggeri
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Michele Libri
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesca Destro
- Department of Pediatric Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
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7
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Cruz SM, Akinkuotu AC, Cass DL, Lee TC, Cassady CI, Mehollin-Ray AR, Ruano R, Welty SE, Olutoye OO. Space occupying lesions in the presence of congenital diaphragmatic hernia. J Pediatr Surg 2016; 51:710-3. [PMID: 26995524 DOI: 10.1016/j.jpedsurg.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/07/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Previous reports describe lung malformations and other chest lesions in association with congenital diaphragmatic hernia (CDH), yet little is known how these lesions affect outcomes. We sought to evaluate the incidence and outcomes of patients diagnosed with chest lesions in association with CDH. METHODS The charts of all infants treated for CDH in a single tertiary center from January 2004 to January 2015 were reviewed. The outcomes of those with space occupying lesions (SOLs) in association with CDH were compared to those with isolated CDH. Statistical analysis was performed using Student's t-test and Mann-Whitney U test for continuous variables and Fisher's exact for categorical variables. RESULTS Of the 214 infants treated, 20 had an associated SOL (4 had>1 lesion). SOLs were confirmed by pathological examination and included: bronchopulmonary sequestration (n=10; 4.7%), ectopic liver (n=9; 4.2%), foregut duplication cyst (n=2; 1%), and other lesions (n=3; 1.4%). No statistical difference was noted in the long-term outcomes of patients with SOL in comparison to those with isolated CDH. CONCLUSION SOLs are not uncommon in neonates with CDH. Despite theoretical concerns, there is no evidence that SOLs are associated with worse outcomes, a finding which is helpful during prenatal counseling of families.
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Affiliation(s)
- Stephanie M Cruz
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Adesola C Akinkuotu
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Darrell L Cass
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Christopher I Cassady
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Stephen E Welty
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Pediatrics-Newborn Section, Baylor College of Medicine, Houston, TX, United States
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.
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8
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Diesen DL, Megison S. Congenital diaphragmatic hernia with associated pulmonary sequestration. J Pediatr 2014; 165:1268-1268.e1. [PMID: 25258149 DOI: 10.1016/j.jpeds.2014.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Diana L Diesen
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center Dallas Children's Medical Center Dallas, Texas
| | - Steve Megison
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center Dallas Children's Medical Center Dallas, Texas
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9
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Beghetti M, Wacker Bou Puigdefabregas J, Merali S. Sildenafil for the treatment of pulmonary hypertension in children. Expert Rev Cardiovasc Ther 2014; 12:1157-84. [DOI: 10.1586/14779072.2014.958077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Lee MY, Won HS, Shim JY, Lee PR, Lee BS, Kim EAR, Kim KS, Kim A. Protective effect of fetal pulmonary sequestration in two cases of postnatal manifestation of congenital diaphragmatic hernia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:719-722. [PMID: 21910148 DOI: 10.1002/uog.10099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We describe two cases of postnatally diagnosed congenital diaphragmatic hernia (CDH) combined with pulmonary sequestration, both of which were diagnosed as isolated pulmonary sequestration on prenatal ultrasound. In these cases, prenatal ultrasonography demonstrated only a hyperechoic mass on the left lower lung and the diaphragm seemed intact. In each case both lungs showed otherwise normal development throughout pregnancy. Pulmonary sequestration may serve as a 'protector', preventing herniation of abdominal contents into the thoracic cavity. The co-occurrence of CDH may be obscured by a lung mass, especially on the left lower lung, and therefore it is necessary to deliver these infants at a tertiary center and parents should be counseled about the possibility of postnatal CDH.
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Affiliation(s)
- M-Y Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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11
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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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12
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Hypoxia in the term newborn: part two-primary pulmonary disease, obstruction, and extrinsic compression. MCN Am J Matern Child Nurs 2009; 34:144-51; quiz 152-3. [PMID: 19550255 DOI: 10.1097/01.nmc.0000351700.12890.da] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric care providers are repeatedly called upon to evaluate a cyanotic newborn in the labor and delivery suite, or in the well-baby nursery. A myriad of disorders spanning all-organ systems exist as possibilities for each of these problems, although several causes for newborn cyanosis are particularly common. In this second of a three-part series, primary pulmonary disease, airway obstruction, and extrinsic compression of the lungs as causes for newborn hypoxia are explored. It is in this group of disorders that we find the answers for the greatest number of these cyanotic dilemmas. Knowledge of the breadth of diagnoses, and respect for the variety of clinical possibilities, is the first step in providing a patient with accurate diagnosis, treatment, and referral.
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13
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Cáceres F, Castañón M, Moreno J, Gratacos E, Lerena J, Ribó J. Hernia diafragmática congénita asociada a secuestro pulmonar, quiste dermoide y duplicación intestinal. An Pediatr (Barc) 2008; 69:181-2. [DOI: 10.1157/13124902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Death due to late-presenting congenital diaphragmatic hernia in a 2-year-old child. Am J Forensic Med Pathol 2008; 29:75-9. [PMID: 19749623 DOI: 10.1097/paf.0b013e318165c09f] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is classically regarded as a neonatal defect presenting with respiratory distress; however, not all CDH will present in this manner. Unlike newborn deaths related to CDH, where the mechanism of death is respiratory in nature, the mechanism of death in late-presenting CDH is not always due to respiratory compromise. In this case report, we present a death occurring in a 2 1/2-year-old child who presented to the emergency department with complaints of abdominal pain and emesis, and then rapidly decompensated and died. Autopsy revealed a CDH, with herniation of abdominal contents into the left thoracic cavity, with associated gastric volvulus, necrosis, and rupture.
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15
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Grethel EJ, Farrell J, Ball RH, Keller RL, Goldstein RB, Lee H, Farmer DL, Harrison MR, Nobuhara KK. Does Congenital Diaphragmatic Hernia Associated with Bronchopulmonary Sequestration Portend a Better Prognosis? Fetal Diagn Ther 2008; 23:250-3. [DOI: 10.1159/000123609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 11/14/2006] [Indexed: 11/19/2022]
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16
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Abstract
Clinically significant pulmonary hypertension (PHTN) is a common finding in newborn infants with congenital diaphragmatic hernia (CDH) resulting in right to left shunting at pre- and postductal level, hypoxemia, and acute right heart failure in those most severely affected. Even in those without clinical manifestations of ductal shunting, cardiac echo studies would suggest that increased pulmonary vascular resistance and right ventricular pressures are almost a universal finding in this disease, and in some instances, may persist well into the postnatal period. The lung is small and structurally abnormal, and the pulmonary vascular bed is not only reduced in size, but responds abnormally to vasodilators. During the last 20 years, "gentle" ventilation, delayed surgery, and improved peri-operative care have made the greatest impact in decreasing mortality in this condition. Use of PGE1 should be considered early if there is hemodynamically significant PHTN, right ventricular dysfunction, and the patent ductus arteriosus (PDA) is becoming restrictive. In individual patients, inhaled nitric oxide (iNO) might be helpful, but the response to iNO should be confirmed using echocardiography. In patients who survive operation and leave the hospital, there are chronic causes of morbidity that need to be looked for and managed in a multi-disciplinary follow-up clinic.
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Affiliation(s)
- Hadi Mohseni-Bod
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Affiliation(s)
- David W Kays
- Division of Pediatric Surgery, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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