Congenital left posterolateral diaphragmatic hernia with previously normal chest x-ray
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Pediatric Radiology
|September 15, 1975
Insights
Congenital posterolateral diaphragmatic hernia can present late, even after a normal infant chest x-ray. The spleen may act as a plug, masking the defect until later in childhood.
Area of Science:
- Pediatric Surgery
- Medical Imaging
- Congenital Abnormalities
Background:
- Congenital posterolateral diaphragmatic hernia (CPDH) is a serious condition often diagnosed in neonates.
- Early diagnosis via chest x-ray is crucial for timely intervention.
- Late-onset presentations of CPDH are less common but pose diagnostic challenges.
Observation:
- Reported are three pediatric cases of left CPDH presenting at 6 months, 2 years, and 6 years.
- All patients had a history of normal chest x-rays in early infancy.
- Two cases showed delayed symptom onset potentially due to splenic herniation.
Findings:
- A normal early chest x-ray does not reliably exclude congenital posterolateral diaphragmatic hernia.
- The spleen may intermittently or persistently obstruct the diaphragmatic defect, mimicking a sealed hernia.
- Late presentation of CPDH can occur despite initial normal radiographic findings.
Implications:
- Clinicians should maintain a high index of suspicion for CPDH in children with unexplained respiratory or gastrointestinal symptoms, regardless of prior imaging.
- Further investigation, including specialized imaging, may be warranted in cases with a history of normal infant chest x-rays.
- This highlights the importance of considering diaphragmatic defects even when initial assessments are unremarkable.
Abstract:
Three patients who presented with left congenital posterolateral diaphragmatic hernia at the ages of six months, two years and six years and who had a normal chest x-ray earlier in life are reported. In two children the late onset of symptoms and previously normal radiographic appearance might be explained by the spleen acting as a plug in the diaphragmatic defect. A normal chest x-ray in early infancy does not exclude the diagnosis of congenital posterolateral diaphragmatic hernia.