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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was an 8 year old female who was treated with antibiotics several times in her first year of life for respiratory infections and was at that time diagnosed with a diaphragmatic hernia containing liver at 10 months of age. She had been followed every two years with ultrasound. Recently she began complaining of vague substernal distress that was sometimes associated with exercise.
Clinical Physical Exam:
Clinical Differential Diagnosis:
The diaphragmatic hernia was demonstrated on chest films, ultrasound, and chest CT exam.
Images 1 and 2
Images 4 and 5
Imaging Differential Diagnosis:
Two months after the chest CT exam, the patient underwent an elective repair of a diaphragmatic hernia at the foramen of Morgagni. The liver was found to be prolapsed into the space behind the sternum, and there was a good deal of scarring along its anterior surface, suggesting it had been sliding back and forth for a long period of time. The diaphragm defect was 6 cm wide, from the xiphoid in front to the vena cava in back.
Diaphragmatic Hernia, Morgagni
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
Case 3, Case 48
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