Case 3

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

Clinical History:
The patient was a newborn 36 week premature female who had several prenatal ultrasound examinations which were unremarkable. On an ultrasound performed just before delivery, at 36 weeks, she was noted to have a right chest mass.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Diaphragmatic hernia

Imaging Findings:
An outside AP chest film showed a right sided chest mass that contained most probably liver and bowel. This was confirmed on a later AP chest film after the patient developed massive pneumoperitoneum, and on an outside chest CT exam.

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Imaging Differential Diagnosis:
Diaphragmatic hernia containing liver and bowel.

Operative Findings:
On the thirteenth hospital day her right diaphragmatic hernia was repaired. She was found to have the right lobe of her liver, small intestine, and cecum in the right chest. The right lung was quite hemorrhagic with blood on the surface.

Pathological Findings:
None

Final Diagnosis:
Diaphragmatic Hernia, Bochdalek, Right

Follow-up and Prognosis:
The post operative course was complicated by hemoperitoneum that was evacuated via a mini-laparotomy. She then suffered multisystem organ failure, from which she did not recover. She died at the age of 9 weeks.

Similar Cases:
Case 8, Case 48

References:

• Paediapedia
• WebPath
• WebPath
• Cornell University Pediatric Pathology

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