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Maedica Mar 2016Presented case was a 36-year-old deceased man with a sequel of poliomyelitis who was reportedly found death at home. On external examination at autopsy, deformity of the...
Presented case was a 36-year-old deceased man with a sequel of poliomyelitis who was reportedly found death at home. On external examination at autopsy, deformity of the lower extremity secondary to polimyelitis, and an obliquely coursing scar tissue 5 cm in length at the same level with the costal arch on the right axillary line were seen. On internal examination at autopsy, diaphragmatic eventration caused by bilateral elevation of the diaphragm towards thoracic cavity was detected. On the left side, stomach, spleen, and small intestines, and on the right side liver were pushed into the thoracic cavity. Cause of death was reported as heart failure of the patient with bilateral diaphragmatic eventration. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic medicine.
PubMed: 28465759
DOI: No ID Found -
JNMA; Journal of the Nepal Medical... Mar 2022Diaphragmatic eventration is a rare condition, and its association with dextrocardia is even a rarer clinical entity. Patients are usually asymptomatic, but the typical...
UNLABELLED
Diaphragmatic eventration is a rare condition, and its association with dextrocardia is even a rarer clinical entity. Patients are usually asymptomatic, but the typical features include rapid breathing and recurrent respiratory infections. Here we present a rare case of a seven months old infant, who presented with cough, noisy breathing and chest retraction. The patient was diagnosed to have dextrocardia with diaphragmatic eventration with pneumonia by chest imaging and was treated in coordination with the medical team for underlying pneumonia. Afterwards, plication of the diaphragm was done through the trans-abdominal approach and the symptoms gradually improved postoperatively. For dextrocardia, since there were no structural abnormalities, the patient was kept in regular follow-up in the pediatric cardiology unit. Though most patients are asymptomatic, diaphragmatic eventration increases the risk of recurrent chest infection and hampers the quality of life of the patient, so timely diagnosis and intervention will greatly improve their quality of life.
KEYWORDS
dextrocardia; diaphragm; diaphragmatic eventration.
Topics: Child; Dextrocardia; Diaphragmatic Eventration; Humans; Infant; Quality of Life; Rare Diseases; Thorax
PubMed: 35633268
DOI: 10.31729/jnma.7029 -
Thorax Jan 1973Nine cases of diaphragmatic eventration are presented in infants, seven of whom required surgery. All were seen during the first 19 months of life and seven were less...
Nine cases of diaphragmatic eventration are presented in infants, seven of whom required surgery. All were seen during the first 19 months of life and seven were less than 1 year old. Although differing from other studies, our cases show a predominance of right-sided lesions. Respiratory symptoms were present in most cases, and digestive symptoms appeared in a lesser number of cases. The radiological changes were pronounced in seven of the nine cases, the dome of the diaphragm reaching to the fourth to fifth intercostal spaces. Regarding surgical technique, the authors favour diaphragmatic plication through the thorax. This gave excellent clinical and radiological results and was without mortality or complications.
Topics: Bronchopneumonia; Cyanosis; Diaphragmatic Eventration; Dyspnea; Feeding and Eating Disorders; Female; Humans; Infant; Male; Radiography; Suture Techniques; Vomiting
PubMed: 4568118
DOI: 10.1136/thx.28.1.66 -
Pediatric Reports Jul 2023The term congenital diaphragmatic eventration (CDE) refers to an anatomical abnormality of the diaphragm. It is a very rare condition; however, early and prompt...
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.
PubMed: 37606445
DOI: 10.3390/pediatric15030041 -
Journal of Medical Cases Apr 2020A 46-year-old woman presented with pain in the lateral side of the left chest wall and a sensation of fullness and pulling in the epigastric region, which started 4...
A 46-year-old woman presented with pain in the lateral side of the left chest wall and a sensation of fullness and pulling in the epigastric region, which started 4 weeks following diaphragmatic plication for left diaphragmatic eventration. The patient was diagnosed as suffering from post-thoracotomy pain syndrome (PTPS). A diagnostic intercostal nerve block relieved the chest wall pain, but not the epigastric pain. After a detailed evaluation, the epigastric pain was postulated to be of diaphragmatic origin and hence a diagnostic phrenic nerve block was performed which relieved the epigastric pain. Combined intercostal nerve neurolysis and phrenic nerve block relieved her pain completely. The phrenic nerve may play a role in pain transmission and the genesis of chronic pain following diaphragmatic surgery. Diaphragmatic pain following surgery may contribute to the development of chronic pain. Phrenic nerve blockade provides diagnostic information regarding the etiology of pain as well as being effective in providing analgesia. The technique of phrenic nerve block is presented and its role in the diagnosis and treatment of pain following thoracic surgery is reviewed.
PubMed: 34434373
DOI: 10.14740/jmc3436 -
Journal of Clinical Medicine May 2023A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration,... (Review)
Review
INTRODUCTION
A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association.
CASE PRESENTATION
A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful.
CONCLUSIONS
CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
PubMed: 37297803
DOI: 10.3390/jcm12113608 -
BMC Surgery May 2021Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a high rate of new mutation and variable expression. Diffuse neurofibroma of the epidermis...
BACKGROUND
Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a high rate of new mutation and variable expression. Diffuse neurofibroma of the epidermis invading deeper organs is rare.We report a case of diffuse subcutaneous neurofibroma in the thoracoabdominal wall which had invaded the diaphragm and caused diaphragmatic eventration.
CASE PRESENTATION
We describe a patient with diffuse neurofibroma of the chest and abdomen who was admitted to the hospital due to sudden abdominal pain and a possible diaphragmatic hernia. We performed thoracotomy and found that the neurofibroma had invaded the diaphragm and caused diaphragmatic eventration.
CONCLUSIONS
This occurrence has not been reported, and it shows that although neurofibromatosis is a benign disease, it still has the biological behavior of a malignant tumor and may cause a serious impact on and damage to other organs.
Topics: Abdominal Wall; Diaphragm; Diaphragmatic Eventration; Hernias, Diaphragmatic, Congenital; Humans; Neurofibroma
PubMed: 34030682
DOI: 10.1186/s12893-021-01258-4 -
Case Reports in Surgery 2018We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged...
We aimed to review the publications on the diagnosis of diaphragmatic eventration and report on the clinical presentation and surgical treatment of a female patient aged 17 years. The present case, though quite infrequent, shows the presence of an ectopic thoracic kidney on the right side. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. The right hemithorax presented invasion of the thin loops, right colon, and kidney. The treatment approach was laparoscopic followed by thoracotomy using a dual mesh. The intrathoracic kidney remained in place. The outcome was satisfactory. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. It represents a clinical and diagnostic challenge; clinicians, radiologists, and surgeons must be alert with a high degree of suspicion in order to correlate symptoms and imaging findings and understand the etiopathogenesis. In addition, they should plan an adequate and individualized surgical repair making use, as far as possible, of the minimally invasive procedures that are currently used.
PubMed: 30631630
DOI: 10.1155/2018/2631391 -
Journal of Clinical Medicine Aug 2023Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of...
Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of diaphragmatic plication (DP) is still underestimated. The aim of the present study is to evaluate the efficacy of minimally-invasive surgical diaphragmatic plication for the management of unilateral diaphragmatic eventration, to the best of our knowledge, this is the largest series reported in the literature using a non-resectional technique. All patients with unilateral diaphragmatic paralysis admitted for diaphragmatic plication (DP) between January 2008 and December 2022 formed the cohort of this retrospective analysis. DP procedure was done to plicate the diaphragm without resection or replacement with synthetic materials. Patients were divided into two groups: Group I included patients who underwent DP through an open thoracotomy, and Group II included patients who underwent DP through video-assisted thoracoscopic surgery (VATS). Data from all patients were collected prospectively and subsequently analyzed retrospectively. Patients' characteristics, lung function tests, radiological findings, type of surgical procedures, complications, and postoperative follow-up were compared. The primary outcome measure was the postoperative result (deeper position of the paralyzed diaphragm) and improvement of dyspnea. The secondary outcome was lung function values over a long-term follow-up. The study included a total of 134 patients who underwent diaphragmatic plication during the study period. 94 (71.7%) were males, mean age of 64 (SD ± 14.0). Group I (thoracotomy group) consisted of 46 patients (35 male). Group II (VATS-group) consisted of 88 patients (69 male). The majority of patients demonstrated impaired lung functions ( = 126). The mean length of diaphragmatic displacement was 8 cm (SD ± 113.8 cm). The mean duration of the entire procedure, including placement of the epidural catheter (EDC), was longer in group I than in group II ( = 0.016). This was also observed for the mean length of the surgical procedure itself ( = 0.031). Most patients in group I had EDC ( = 38) ( = 0.001). Patients in group I required more medication for pain control ( = 0.022). A lower position of the diaphragm was achieved in all patients ( < 0.001). The length of hospital stay was 7 (SD ± 4.5) days in group I vs. 4.5 (SD ± 3.2) days in group II ( = 0.036). Minor complications occurred in 3% ( = 4) in group I vs. 2% ( = 3) in group II. No mortality was observed in any of the groups. Postoperative follow-up of patients at 6, 12, and 24 months showed a significant increase in forced vital capacity (FVC) up to 25% (SD ± 10%-35%) ( = 0.019), in forced expiratory volume in 1 s (FEV1) up to 20% (SD ± 12%-38%) in both groups ( = 0.026), also in the diffusion capacity of carbon monoxide (DLCO) up to 15% (SD ± 10%-20%) was noticed in both groups. Chronic pain symptoms were noted in 13% ( = 6) in group I vs. 2% ( = 2) in group II ( = 0.014). Except for one patient in group II, no recurrence of DE was observed. Diaphragm plication is an effective procedure to reduce debilitating dyspnea and improve lung function in patients suffering from diaphragm eventration. Minimally invasive diaphragmatic plication using VATS procedures is a safe and feasible procedure for the management of unilateral diaphragmatic paralysis. VATS-DP is superior to open procedure in terms of pain management and length of hospital stay, hence, accelerated recovery is more likely. Careful patient selection is crucial to achieving optimal outcomes. Prospective studies are needed to validate these results.
PubMed: 37629343
DOI: 10.3390/jcm12165301 -
BMC Gastroenterology Feb 2022Type 2 isolated dextrogastria in conjunction with protrusion of the right hemidiaphragm and hiatal hernia is an uncommon anomaly among all transpositions of the viscera....
BACKGROUND
Type 2 isolated dextrogastria in conjunction with protrusion of the right hemidiaphragm and hiatal hernia is an uncommon anomaly among all transpositions of the viscera. Clear diagnosis is not straightforward in such cases both clinically and with various imaging techniques leaving often only laparotomy for diagnosis.
CASE PRESENTATION
Here, we discuss the case of a so far asymptomatic 19-year-old male, who had a 3-month history of abdominal pain and 2 days of vomiting with absolute constipation, and reduced air entry in the base of the right lung. A large air fluid level was found in the right lower hemithorax, furthermore, a loss of the normal diaphragmatic outline, and paucity of the bowel gases in the rest of the abdomen. Computer tomography with contrast was suggestive of loss of right lung volume, with stomach and bowel loops herniating into the right hemithorax and compressive atelactatic changes in the adjacent lung alongside an enlarged liver. A barium test showed the stomach fundus and body posteriorly positioned, while both duodenal bulb loops and the duodeno-jejunal junction alongside the small and large bowels were detected in their normal positions.
CONCLUSION
In case of visceral transpositions, routine diagnostic blood and radiological tests may lead the health care provider to misdiagnosis. It is necessary, in particular when surgery is required, to carefully elucidate the organ anomaly. The use of additional imaging and radiological methods may be called for; CT scan and a barium test were critical here. This is the first case of isolated dextrogastria with eventration of right hemidiaphragm and hiatal hernia reported from Pakistan providing insights for diagnostic procedures.
Topics: Abdomen; Adult; Hernia, Hiatal; Humans; Male; Radiography; Situs Inversus; Stomach; Young Adult
PubMed: 35144537
DOI: 10.1186/s12876-022-02127-x