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

Case 26

Clinical History:
The patient was a female diagnosed in utero with a diaphragmatic hernia on prenatal ultrasound. The patient was delivered at full term. She developed respiratory distress at birth requiring placement on a ventilator, that progressively worsened, eventually requiring placement onto extracorporeal membrane oxygenation (ECMO).

Clinical Physical Exam:
The patient had a profound respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Diaphragmatic hernia

Imaging Findings:
Chest film from the first day of life showed complete opacification of the left lung and a right pneumothorax.

Image 1

Imaging Differential Diagnosis:
Diaphragmatic hernia.

Operative Findings:
The patient underwent an operative repair of her diaphragmatic defect on the seventh day of life. A large defect on the left diaphragm was found which required a 5 x 7 cm Gore-Tex patch to cover.

Follow-up and Prognosis:
Postoperatively the patient did not show any improvement in her respiratory status. On postoperative day 9, the patient was removed from ECMO and ventilatory support and allowed to expire. A post mortem examination was performed.

Pathological Findings:
Post mortem examination showed the left and right lungs to be marked hypoplastic.

Image 2

Image 3

Image 4

Final Diagnosis:
Diaphragmatic Hernia, Bochdalek, Left-sided

Similar Cases:
Case 8, Case 11, Case 17, Case 22

References:

• Paediapedia
• WebPath
• WebPath
• Cornell University Pediatric Pathology

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