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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.
Annals of Emergency Medicine
|July 1, 1993
Summary
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.