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Hydrothorax, ascites, and right diaphragmatic hernia

V Gilsanz, D Emons, M Hansmann

    Radiology
    |January 1, 1986
    PubMed

    Insights

    Right diaphragmatic hernias in children can cause hydrothorax and ascites due to incarcerated sacs. Lymphatic obstruction is the likely cause, potentially leading to life-threatening lung hypoplasia.

    Area of Science:

    • Pediatric Surgery
    • Neonatal Medicine
    • Medical Imaging

    Background:

    • Right diaphragmatic hernia is a congenital defect where abdominal organs, notably the liver, protrude into the chest cavity.
    • Associated hydrothorax and ascites are significant clinical findings in affected neonates.
    • Understanding the pathophysiology is crucial for timely diagnosis and management.

    Observation:

    • Five pediatric cases of right diaphragmatic hernia with liver herniation were analyzed.
    • Clinical presentations included hydrothorax (3/5), hydrothorax with ascites (1/5), and ascites (1/5).
    • Surgical or autopsy findings revealed incarcerated peritoneal sacs containing fluid in the thoracic cavity in cases of large hydrothorax.

    Findings:

    • Lymphatic congestion and obstruction are implicated as the primary cause of fluid accumulation (hydrothorax/ascites).
    • This fluid collection can progressively enlarge, posing a life-threatening risk.
    • Two neonates with severe lung hypoplasia secondary to the condition did not survive; intrauterine interventions were attempted.
    • Two survivors underwent successful surgical repair at 1 week and 7 months of age.
    • Ascites in two patients was attributed to hepatic venous obstruction, similar to Budd-Chiari syndrome.

    Implications:

    • Early detection via fetal ultrasonography of intrathoracic masses is vital.
    • Prompt surgical intervention can lead to favorable outcomes.
    • The pathophysiology highlights the critical role of lymphatic and venous systems in congenital diaphragmatic abnormalities.
    • This condition underscores the need for specialized neonatal care and surgical expertise.

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