Related Experiment Videos
Diaphragmatic hernia masquerading as pneumothorax in two toddlers
J A Fein1, J Loiselle, S Eberlein
1Division of General Pediatrics, Emergency Medicine, Children's Hospital of Philadelphia, Pennsylvania.
Insights
Two toddlers experienced respiratory distress due to acquired diaphragmatic hernias, initially mistaken for pneumothorax. Prompt nasogastric tube insertion resolved symptoms, highlighting the need to consider diaphragmatic hernias in infants with unilateral lung findings.
Area of Science:
- Pediatric Emergency Medicine
- Neonatal Surgery
- Radiology
Background:
- Unilateral lung findings in pediatric respiratory distress can mimic pneumothorax.
- Congenital diaphragmatic hernias are typically diagnosed neonatally.
Observation:
- Two toddlers presented with acute respiratory distress and unilateral lung findings suggestive of pneumothorax.
- Initial interventions included thoracostomy and chest tube insertion.
- Subsequent imaging revealed diaphragmatic hernias with abdominal contents in the chest.
Findings:
- Nasogastric tube insertion successfully relieved respiratory distress in both cases.
- The diaphragmatic hernias were likely acquired due to aerophagia or mild trauma.
- This presentation mimics "acquired" congenital diaphragmatic hernias.
Implications:
- Early recognition of acquired diaphragmatic hernias can prevent unnecessary invasive procedures.
- Consider diaphragmatic hernias in the differential diagnosis for infants with acute respiratory distress and unilateral lung findings.
- Nasogastric tube placement is a crucial diagnostic and therapeutic step in suspected acquired diaphragmatic hernias.
Abstract:
In two separate incidents, two toddlers with no previous history of respiratory ailments presented to the emergency department of a children's hospital with progressive respiratory distress. Both children had unilateral lung findings on auscultation and initial chest radiographs that were consistent with a pneumothorax. Thoracostomy and chest tube insertion were performed during initial resuscitation efforts. In both cases, subsequent radiographs revealed that the stomach was located in the left hemithorax, suggestive of a diaphragmatic hernia. Nasogastric tube insertion relieved the respiratory distress of these two children. Recognition of the "acquired" congenital diaphragmatic hernia in the setting of extreme aerophagia or mild abdominal trauma may prevent unnecessary procedures during the resuscitation of children with acute respiratory distress and unilateral lung findings.