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Mediastinal Hernia


Presentation

  • Here we present a case of a 75-year-old patient with a clinical history of chronic obstructive pulmonary disease and emphysema presenting with a right contralateral pneumothorax secondary to a trans-mediastinal herniated lung bullae.[academic.oup.com]
  • Case 3 —A 74-year-old man underwent THE for well-differentiated adenocarcinoma of his distal esophagus (T1N0M0) 10 years before presenting with biliary colic.[mdmag.com]
  • Presented at the 5th Conference on General Thoracic Surgery, Wroclaw, Poland, 24–27 September, 1997.[academic.oup.com]
  • Presented by Monica T Young, MD at the SS03: Foregut 1 held during the 2017 SAGES Annual Meeting in Houston, TX on Wednesday, March 22, 2017 Keyword(s): aerolar tissue, aorta, avascular plane, azygous vein, benign Schwannoma, Bougie, chyle leak, circumferential[sages.org]
  • We present a case of mediastinal lung herniation associated with pulmonary sequestration, which was confirmed both surgically and pathologically in a 13-year-old girl initially admitted with a diagnosis of pneumonia.[ncbi.nlm.nih.gov]
Pseudotumor
  • Nevertheless the benign nature of the encapsulated pseudotumor and its easy dissection from the surrounding mediastinal tissue was an important prerequisite to perform resection by this way.[academic.oup.com]
Mediastinal Disease
  • disease Mediastinal radiation fibrosis Retraction of mediastinum Applies To Fibrosis of mediastinum Hernia of mediastinum Retraction of mediastinum ICD-9-CM Volume 2 Index entries containing back-references to 519.3 :[icd9data.com]
  • Diseases Mediastinal mass (tumor) excision and biopsy A mediastinal tumor is a growth that forms in area of the middle of the chest between the sternum and spine and between the lungs (mediastinum) Mediastinoscopy for staging and diagnosis A mediastinoscopy[uihc.org]
Paroxysmal Cough
  • The neighborhood of cyst with bifurcation of trachea can cause paroxysmal cough, dyspnea and respiratory disturbances. Paraesophageal location of the cyst manifests by dysphagia.[intranet.tdmu.edu.ua]
Early Satiety
  • […] the SS03: Foregut 1 held during the 2017 SAGES Annual Meeting in Houston, TX on Wednesday, March 22, 2017 Keyword(s): aerolar tissue, aorta, avascular plane, azygous vein, benign Schwannoma, Bougie, chyle leak, circumferential ligation, crus, CT scan, early[sages.org]
  • An 80-year-old gentleman who had a long-standing history of chest pain, early satiety and shortness of breath especially after large meals presented to the emergency department with chest pain.[saudijgastro.com]
  • Case presentation A 55-year-old Chinese woman presented with a history of left hypochondrial pain for a duration of one year, associated with early satiety and postprandial vomiting. She did not report any reflux symptoms.[jmedicalcasereports.biomedcentral.com]
  • Postprandial bloating and early satiety are related to compression of the proximal stomach, whereas postcibal pain is usually related to gastric torsion.[nature.com]
  • The authors did not find any significant difference between a control group and the vagotomized group in terms of symptoms like abdominal pain, bloating, diarrhea, or early satiety.[sages.org]
Biliary Colic
  • Case 3 —A 74-year-old man underwent THE for well-differentiated adenocarcinoma of his distal esophagus (T1N0M0) 10 years before presenting with biliary colic.[mdmag.com]

Workup

  • As part of the workup for the bile leak, he underwent an abdominal CT scan, which revealed herniation of the small bowel and a portion of the splenic flexure of the large colon into the mediastinum (Figure 6).[mdmag.com]
  • Henry Harold Friedman Lippincott Williams & Wilkins, 01.01.2001 - 441 Seiten Now in its updated Seventh Edition, this popular Spiral(R) Manual is a step-by-step guide to the diagnostic workup of 75 of the most common clinical problems in internal medicine[books.google.de]
  • Henry Harold Friedman Lippincott Williams & Wilkins , 1 ian. 2001 - 441 pagini Now in its updated Seventh Edition, this popular Spiral(R) Manual is a step-by-step guide to the diagnostic workup of 75 of the most common clinical problems in internal medicine[books.google.ro]
Pleural Adhesions
  • Right pleurodesis was performed using Talc and a left posterior thoracoscopy showed a severe emphysematous left lung with a lingular herniated bulla to the right hemithorax through an anterior mediastinal pleural defect along with pleural adhesions (Figs[academic.oup.com]

Treatment

  • Focus on evidence-based treatments and outcomes to apply today’s best practices.[books.google.com]
  • Gastroesophageal hernia requires surgical treatment. Refusal of the treatment leads to the increased risk of developing esophageal cancer.[bookinghealth.com]
  • Treatment for TOS includes physical therapy, medications, and weight loss.[medstarfranklinsquare.org]
  • Tactics and choice of treatment In most cases the asymptomatic course of diaphragmatic relaxation requires no special treatment.[intranet.tdmu.edu.ua]
  • […] herniation through the diaphragmatic defect excluding the stomach is rare, which was mostly misdiagnosed as a mediastinal lipoma previously. [1] , [3] , [4] Surgery is the first choice for patients with symptomatic diaphragmatic hernia; however, the surgical treatment[njcponline.com]

Prognosis

  • BMJ. 2014;349:g6154 Links: aetiology mechanisms of the oesophgeal-gastric valve clinical features treatment and prognosis complications[gpnotebook.co.uk]
  • If the ratio is 1 or less the prognosis is extremely poor (despite the patient receiving ECHMO post birth). Ratios of 1.0 to 1.4 is associated with a 38% survival, however the majority require ECHMO.[fetalultrasound.com]
  • Fetal surgery for severe cases requires proper evaluation of the prognosis of fetuses with CDH.[intechopen.com]
  • However, if a liposarcoma had been found, the prognosis would have been quite poor. 1 Mediastinal liposarcomas often invade adjacent vital organs, and microscopically complete tumour resection is difficult.[pmj.bmj.com]

Etiology

  • The etiology of this finding is justified by the retention of radioiodinated body fluids (saliva, tears, blood, urine, exudate, transudate, gastric, mucosal secretions, etc.) [6] that is, responsible for false-positive I-131 scan findings.[ijnm.in]
  • Extremity abnormalities and spinal dysraphism may suggest syndromic congenital diaphragmatic hernia Risk factors and etiological factors The cause is not completely understood.[medicaljoyworks.com]
  • Seite 372 - Either (1) or (2): (1) Evidence from the history, physical examination, or laboratory tests of a specific organic factor (or factors) judged to be etiologically related to the disturbance. (2) In the absence of such evidence, an etiologic[books.google.de]
  • Pagina 372 - Either (1) or (2): (1) Evidence from the history, physical examination, or laboratory tests of a specific organic factor (or factors) judged to be etiologically related to the disturbance. (2) In the absence of such evidence, an etiologic[books.google.ro]
  • Bowel obstructions have been known to occur, but the etiology typically has been attributed to causes other than the mediastinal herniation.[mdmag.com]

Epidemiology

  • Epidemiology [ edit ] Bochdalek hernias make up about 0.17% to 6% of all diaphragmatic hernia cases when they appear spontaneously in adults and about one in every 2200 to 12,500 births every year. [2] Babies who are born with a Bochdalek hernia are more[en.wikipedia.org]
  • Congenital diaphragmatic hernia, Epidemiology and outcome. Clin Perinatol. 1996;23:671–88. 7. Nitecki S, Bar-Maor JA. Late presentation of Bochdalek hernia; our experience and review of the literature. Isr Med Sci. 1992;28:711–4. 8.[sjtrem.biomedcentral.com]
  • With proper patient selection, laparoscopic fundoplication recent studies have indicated relatively low complication rates, quick recovery, and relatively good long term results. [11] [12] [13] [14] [15] Epidemiology [ edit ] Incidence of hiatal hernias[en.wikipedia.org]
  • Overview of epidemiology, genetics, birth defects, and chromosome abnormalities associated with CDH. Am J Med Genet C Semin Med Genet. 2007; 145C(2): 158-71. [ Links ] 12. Bremer JL. The diaphragm and diaphragmatic hernia.[scielo.isciii.es]
  • Epidemiology CDH is a rare condition that occurs in 1 ].[intechopen.com]
Sex distribution
Age distribution

Pathophysiology

  • Initial theories about pathophysiology of this condition centered on the presence of herniated viscera within the chest and need for its prompt removal.[ijri.org]
  • It requires considerable experience with minimally invasive surgery of the foregut, and a complete understanding of esophageal pathophysiology.[websurg.com]
  • A likely chain of pathophysiology events leading to tension gastrothorax is described by Horst et al. [ 2 ]. At some point increased abdominal pressure herniates the stomach through a preexisting defect in the diaphragm.[sjtrem.biomedcentral.com]
  • A variety of lines of evidence suggest that hiatal hernia is a significant pathophysiologic factor in approximately 50% of instances.[nature.com]
  • Pathophysiology Extrinsic compression of the superior vena cava is possible because it has a thin wall coupled with a low intravascular pressure. Because the superior vena cava is surrounded by rigid structures, it is relatively easy to compress.[intranet.tdmu.edu.ua]

Prevention

  • Complete sac excision, avoiding tight crural closure along with aggressive post-operative chest physiotherapy could prevent such complication in the future.[saudijgastro.com]
  • In gastrointestinal fluoroscopic imaging, the presence of retrocardiac air can be highly suggestive of bowel herniation. 5 During the initial THE, surgical narrowing of the esophageal hiatus is not required as a preventative measure.[mdmag.com]
  • Normally, there are several mechanisms to prevent acid from flowing backwards (refluxing) up into the oesophagus.[lapsurgeryaustralia.com.au]
  • prevented erosion into the esophagus.[nwsurgeons.com]
  • Treatment aims to ease symptoms and prevent further damage. Doctors may prescribe medication to treat heartburn. If symptoms cannot be controlled, surgery may be needed. Prevention Small lifestyle changes may help prevent hernias.[virtualpediatrichospital.org]

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