Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
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 Differential Diagnosis:
Diaphragmatic Hernia, Cystic Adenomatoid Malformation, Congenital Lobar Emphysema
An AP chest film obtained at birth demonstrated an opacified right hemithorax with several air filled structures within it.
Imaging Differential Diagnosis:
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.
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.
Case 11, Case 17, Case 22, Case 26
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