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Virtual Pediatric Hospital: Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology: Case 8

Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 8

Michael P. D'Alessandro, M.D.,
Steven J. Fishman, M.D.,
Deborah E. Schofield, M.D.

Peer Review Status: Internally Peer Reviewed
Chief Complaint:
Four day old full term female with a congenital chest mass.

Clinical History:
The patient was a full term female born with a right-sided congenital chest mass that was diagnosed on prenatal ultrasound as a diaphragmatic hernia. Immediately after birth she was maintained on conventional ventilation, but soon afterwards her respiratory status worsened and she then required placement on veno-veno Extra Corporeal Membrane Oxygenation (ECMO).

Clinical Physical Exam:
The infant was in marked respiratory distress.

Clinical Labs:

Clinical Differential Diagnosis:
Diaphragmatic Hernia, Cystic Adenomatoid Malformation, Congenital Lobar Emphysema

Imaging Findings:
An AP chest film obtained at birth demonstrated an opacified right hemithorax with several air filled structures within it.

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Imaging Differential Diagnosis:
Diaphragmatic Hernia

Operative Findings:
On the fourth day of life the hernia was repaired. The abdomen was entered through a right subcostal incision. A large diaphragmatic defect was identified. The diaphragm had a large anterior leaflet and a smaller posterior leaflet. The entire liver except for the left lateral segment was in the thoracic cavity. A large quantity of small intestine as well as the upper aspect of the right kidney was also in the thoracic cavity. The diaphragm defect was repaired with the addition of a Gore-Tex patch measuring 4 x 5 cm.

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Pathological Findings:

Final Diagnosis:
Diaphragmatic Hernia, Bochdalek, Right Sided

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. Imaging studies obtained at 1 year of age showed a typical post operative appearance.

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Similar Cases:
Case 11, Case 17, Case 22, Case 26


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