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Congenital diaphragmatic hernia: atypical presentation
A M Nadroo1, R Levshina, A Tugertimur
1Department of Pediatrics, New York Methodist Hospital, USA. Alinadroo@aol.com
Journal of Perinatal Medicine
|November 24, 1999
Summary
A rare left-sided diaphragmatic hernia, where the liver obstructed intestinal herniation, presented delayed symptoms in a newborn. This case highlights the need for advanced imaging like CT scans for accurate diagnosis.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Diagnostic Imaging
Background:
- Diaphragmatic hernias are congenital defects allowing abdominal organs into the chest.
- Left-sided diaphragmatic hernias are common, but atypical presentations can occur.
- Antenatal ultrasound is standard for fetal anomaly screening.
Observation:
- A full-term infant presented with tachypnea hours after birth, despite normal antenatal scans.
- Initial chest X-ray showed left-sided haziness without mediastinal shift, and breath sounds were diminished.
- Computed tomography (CT) revealed a left-sided diaphragmatic hernia with liver herniation compressing the lung.
Findings:
- The left lobe of the liver obstructed intestinal herniation into the thoracic cavity.
- Clinical symptoms of respiratory distress manifested several hours after birth, not immediately.
- Standard physical examination and chest X-ray were inconclusive for definitive diagnosis.
Implications:
- Large left-sided diaphragmatic hernias can be missed on antenatal sonography.
- Delayed presentation of symptoms is possible, even with liver herniation.
- CT scanning is crucial for diagnosing complex or atypical diaphragmatic hernias.