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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 8 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 8

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
An 8 year old female with substernal distress.

Clinical History:
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 Labs:

Clinical Differential Diagnosis:
Diaphragmatic hernia

Imaging Findings:
The diaphragmatic hernia was demonstrated on chest films, ultrasound, and chest CT exam.

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Imaging Differential Diagnosis:
Morgagni Hernia

Operative Findings:
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.

Pathological Findings:

Final Diagnosis:
Diaphragmatic Hernia, Morgagni

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 3, Case 48


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