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Diaphragmatic Eventration


Presentation

  • We describe a patient who presented with a left lower lobe lung lesion suspicious for cancer with possible hilar involvement. Intraoperatively, we found a primary left phrenic nerve tumor, diaphragmatic eventration, and left lower lobe atelectasis.[ncbi.nlm.nih.gov]
Streptococcal Infection
  • We report a child with antenatally documented right diaphragmatic eventration 4 weeks before birth who subsequently developed a beta-haemolytic streptococcal infection in the neonatal period.[ncbi.nlm.nih.gov]
Hiccup
  • Hiccups: A subtle sign in the clinical diagnosis of gastric volvulus and a review of the literature. Dig Dis Sci Nov 2008;53:3033-6. 6. Dogan NO, Aksel G, Demircan A, Keles A, Bildik F.[archintsurg.org]
Regurgitation
  • He died from cardiac failure due to severe tricuspid and mitral regurgitation at 62 h of age.[ncbi.nlm.nih.gov]
Recurrent Vomiting
  • We report a case of such an association in a 2-month-old boy who presented with tachypnea aggravated by feeding and recurrent vomiting.[ncbi.nlm.nih.gov]
Tachycardia
  • Supraventricular tachycardia is the most common symptomatic arrhythmia in young patients, frequently associated with Wolff-Parkinson-White (WPW) syndrome.[ncbi.nlm.nih.gov]
  • On clinical examination, he was found to be tachypneic with tachycardia and moderate dehydration. Fullness was seen in the epigastrium. There was minimal tenderness over the left hypochondrium with no palpable lumps.[archintsurg.org]
Liver Dysfunction
  • Extravascular liquid accumulation was probably further aggravated by hypoproteinaemia secondary to liver dysfunction resulting from the venous congestion and cardiac failure.[ncbi.nlm.nih.gov]

Workup

Mediastinal Shift
  • A mediastinal shift to the contralateral side may cause significant compression of the affected chest contents, resulting in compromised pulmonary function, especially when both sides are involved.[ncbi.nlm.nih.gov]
  • In adults, mostly it is asymptomatic, usually it involves left hemidiaphragm with right sided mediastinal shift [ 1 ].[omicsonline.org]
  • […] gastric and colonic herniation in left chest cavity with collapsed lung and mediastinal shift to the right.[archintsurg.org]
  • Chest radiography was revealed total elevation of the right dome in 3 cases and of the left dome in 2 cases above the fourth intercostal space (figure1) and a mediastinal shift in 2 cases Figure 1 : Preoperative chest radiography shows elevation of the[latunisiemedicale.com]
  • X-ray abdomen in erect position showed raised left hemidiaphragm with a large air-fluid level in the left hypochondrium, paucity of distal gas and right mediastinal shift [Fig.1].[casereports.in]
Mediastinal Mass
  • Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral.[ncbi.nlm.nih.gov]
  • Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: Imaging modalities and literature review. Eur J Radiol 2004;51:85-90. [ PUBMED ] 11. Salami MA, Adebo OA.[njbcs.net]
Unilateral Diaphragmatic Elevation
  • SUBJECTS AND METHODS: Between October 2007 to December 2013, 3498 children with congenital heart disease underwent cardiac surgery in our hospital, and 40 (1.14%) of them had unilateral diaphragmatic elevation on postoperative chest X-ray (mean elevation[ncbi.nlm.nih.gov]
Pericardial Effusion
  • We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion.[ncbi.nlm.nih.gov]
Right Pleural Effusion
  • This is a report of a 10-day-old term female infant with right diaphragmatic eventration in whom the initial diagnosis was right pleural effusion with probable ipsilateral lung hypoplasia.[ncbi.nlm.nih.gov]
Hypercapnia
  • It is characterized by a lack of response to habitual respiratory stimulants, especially hypercapnia. In this article, the management of this syndrome by diaphragmatic pacing is discussed.[ncbi.nlm.nih.gov]
  • The development of respiratory acidosis with hypercapnia and hypoxia must be avoided as this would trigger off the reactive pulmonary hypertension so one should err on the side of over ventilation rather than underventilation.[jpma.org.pk]

Treatment

  • OBJECTIVE: This study sought to summarize the diagnostic and treatment aspects of congenital diaphragmatic eventration (CDE) in children by retrospectively analyzing their medical records to identify and understand the complications of CDE, its treatment[ncbi.nlm.nih.gov]

Prognosis

  • Prenatal differential diagnosis of eventration is critical because postnatal managing and prognosis of these conditions vary significantly.[ncbi.nlm.nih.gov]
  • After surgical treatment, the long-term prognosis is good. For severely symptomatic patients who were on the ventilator before surgery, diaphragmatic plication can help come off mechanical ventilator support. Updated: 11/2016 Author: Romeo C.[eapsa.org]

Etiology

  • In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.[ncbi.nlm.nih.gov]
  • The etiology of diaphragm paralysis is usually defined based on the history and previous chest X-ray of the patients.[cardiothoracicsurgery.biomedcentral.com]
  • The etiology of diaphragmatic dysfunction includes both congenital and acquired conditions.[annalscts.com]

Epidemiology

  • Clinical and epidemiological characteristics of infants with body wall complex with and without limb deficiency. Am J Med Genet. 1997;73:170–5. Google Scholar [5] Van Allen MI, Curry C, Gallagher L. Limb body wall complex: I. Pathogenesis.[degruyter.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology: Eventration of the diaphragm causes problems in 4 ways: Inability to ventilate the ipsilateral lung Direct Compression of the ipsilateral lung Pneumonia due to chronic atelectasis Paradoxical motion of the diaphragm making ventilation[surgery4children.com]

Prevention

  • Essential steps to prevent any rise in intrathoracic and intra-abdominal pressures along with care to minimize intragastric volume were taken.[ncbi.nlm.nih.gov]
  • Early diagnosis and prompt intervention prevents development of necrosis and perforation of stomach.[archintsurg.org]
  • This prevented his right lung from developing. The baby was later diagnosed with bowel, kidney and heart disease.[chop.edu]
  • Attaching the diaphragm patch to the thoracic wall, as was done in this study, may prevent the re-elevation of the diaphragm postoperatively.[academic.oup.com]

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