1/80. Diaphragmatic rupture after epidural anaesthesia in a patient with diaphragmatic eventration. An 85-year-old man with undiagnosed eventration of the left hemidiaphragm had an above-knee amputation under epidural anaesthesia. His post-operative course was stormy with two episodes of cardiovascular collapse. On the third post-operative day, rupture of the left hemidiaphragm was diagnosed, the bowel had herniated into the left hemithorax. It is proposed that the left hemidiaphragm ruptured spontaneously because of muscular weakness secondary to the thoracic segmental blockade associated with lumber epidural anaesthesia. ( info) |
2/80. Cephalad renal ectopia, duplication of pelvicalyceal system and patent ductus arteriosus in an adult female. An unusual cause for a shadow in the plain CX-ray of a female with uncomplicated patent ductus arteriosus is presented herein. The chest CT scan and IVU revealed the presence of a high (cephalad) right kidney in an eventrated hemidiaphragm. A bifid ureter and duplication of the pelvis were found in the contralateral kidney. This constellation of anomalies is exceedingly rare. ( info) |
3/80. Thoracoscopic plication of diaphragmatic eventration using endostaplers. Unilateral diaphragmatic eventration and paralysis require plication in cases of progressive dyspnea on exertion and recurrent respiratory infection. The patient, a 40-year-old woman, who had complained of worsening dyspnea on exertion and elevation of the left diaphragm on chest radiographs for 4 years, underwent plication by thoracoscopy with knifeless endostaplers. Improvements in pulmonary functions and dyspnea on exertion have been maintained for 14 months. ( info) |
4/80. Split cord malformation with partial eventration of the diaphragm. Case report. The authors describe the case of a 3-year-old girl who presented with a dorsal split cord malformation (SCM) and was found to have eventration of the diaphragm. Although the child did not undergo surgery for eventration, its presence suggests a need for careful preoperative planning and clinical evaluation to rule out or confirm the anomalies associated with spinal dysraphism or SCM. ( info) |
5/80. Bilateral eventration of the diaphragm with perforated gastric volvulus in an adolescent. Bilateral congenital eventration of the diaphragm almost uniformly presents in infancy with respiratory compromise and is associated with a high mortality rate. Delayed presentation of diaphragmatic eventration in older children and adults may be associated with acute gastric volvulus. Thus, any patient with abdominal pain, vomiting, or nonspecific gastrointestinal symptoms in association with abnormal diaphragmatic findings on chest x-ray should undergo further diagnostic workup with upper gastrointestinal series or computed tomography (CT) scan. Treatment of gastric volvulus requires immediate surgical repair to prevent subsequent necrosis and perforation. The authors describe a case report of bilateral congenital diaphragmatic eventration complicated by a perforated gastric volvulus in a 13-year-old boy. Emergent reduction of the volvulus, closure of the perforated stomach, plication of the diaphragm, and placement of gastrostomy was performed successfully. ( info) |
6/80. Spondylothoracic dysplasia with diaphragmatic defect: a case report with literature review. Spondylothoracic dysplasia (Jarcho-Levin syndrome) is a syndrome of unknown etiology. We describe a new case with diaphragmatic eventration. literature review for cases of Jarcho-Levin syndrome with diaphragmatic defects, which were six cases, revealed that renal affection increased when diaphragmatic defects associate the syndrome with pulmonary hypoplasia. Thus, the subgroup of spondylothoracic dysplasia with diaphragmatic defect is a more severe subgroup of the syndrome rather than the other forms of this syndrome. Relating the described anomalies in this case and that of the literature cases to the known embryological basis may point to a pivotal developmental link between lung, kidney and diaphragm, possibly the posterior mesenchyme. ( info) |
7/80. Left diaphragmatic eventration with a suprapubic spleen: report of a case. Diaphragmatic defects such as eventration and hernia are known to be associated with a high-sited, sometimes intrathoracic spleen. We report here a unique case of an 8-year-old boy found to have a left congenital diaphragmatic eventration and a suprapubic wandering spleen after presenting with symptoms of an "acute abdomen" due to torsion of the splenic pedicle. To our knowledge only one other case of a similar paradoxical association of these anomalies has been reported before; interestingly, in this patient splenic infarction had also resulted secondary to splenic torsion. We recommend careful evaluation of the location and vascular status of the spleen in all patients with congenital diaphragmatic defects due to the common occurrence of splenic vascular insult. ( info) |
| 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. He was successfully treated with total excision of the tumor and plication of the diaphragm. Histopathology was consistent with schwannoma of the phrenic nerve. diaphragmatic eventration is an uncommon presentation of a phrenic nerve schwannoma, which is itself a rarely occurring tumor. Surgical resection of the tumor and diaphragmatic plication is the primary modality of management in these patients. ( info) |
9/80. Incarcerated diaphragmatic hernia secondary to plication for eventration of diaphragm. Diaphragmatic plication is the procedure of choice for congenital diaphragmatic eventration. In the absence of complications, most newborns with eventration do well after plication and have normal long-term respiratory functions. However complications are rare. recurrence, ipsilateral pneumothorax and rupture of the diaphragm have been reported in literature. We report a case of incarcerated diaphragmatic hernia in a two-year-old child who had undergone plication for eventration of the diaphragm at six months of age. ( info) |
10/80. Multiple ipsilateral congenital diaphragmatic pathologies: rarities to consider. BACKGROUND: Bilaterality of congenital diaphragmatic pathologies is well documented in the English literature. Nevertheless, ipsilateral simultaneous congenital diaphragmatic pathologies, though rare, are worth revisiting to shed more light into their embryology and management. methods: A review of the literature for reported cases of multiple ipsilateral congenital diaphragmatic pathologies was performed. Their findings, management and outcomes were classified and reviewed, in addition to reporting and comparison with a new case from our medical center. RESULTS: Two patients were adult females with multiple defects in the right central tendon of the diaphragm. The remaining four were all pediatric cases. Two had double congenital hernial defects on the same side and two had the defect associated with ipsilateral diaphragmatic eventration. Our case is the third one with diaphragmatic eventration, but the first being associated with a posterolateral defect on the same side. Its presentation with acute rectal bleeding proved difficult to diagnose. CONCLUSION: There are various postulated theories concerning the pathogenesis of ipsilateral pathologies during embryologic development of the diaphragm. Management of asymptomatic congenital eventrations remains debatable. However, when symptoms become apparent, ipsilateral defects though rare, should be considered and prompt surgical management through a thoracotomy or laparotomy approach is recommended. ( info) |