Pediatrics |

Diaphragmatic Eventration Misdiagnosed as Diaphragmatic Hernia in a Preterm Infant FREE TO VIEW

John Bishara, DO; Sathyaprasad Burjonrappa, MD; Melodi Pirzada, MD; Claudia Halaby, MD
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Winthrop Univeristy, Mineola, NY

Chest. 2015;148(4_MeetingAbstracts):780A. doi:10.1378/chest.2243317
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SESSION TITLE: Pediatrics Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Eventration of diaphragm is a congenital anomaly that results from a failure of muscular development of part or all of the hemidiaphragm. Clinically, eventration of diaphragm refers to an abnormal elevation of an intact diaphragm (1). In some cases, it may be difficult to distinguish it from congenital diaphragmatic hernia (CDH). Complete diaphragmatic eventration almost invariably occurs on the left side.

CASE PRESENTATION: 3-week-old male, born prematurely at 30 weeks GA, developed respiratory distress, 2 weeks after being weaned off respiratory support. A chest x-ray obtained at that time (fig. 1), when compared with the one from dol#1 showed a new right lower lobe (RLL) opacity, suggestive of atelectasis. He was placed on CPAP for lung recruitment, without imaging improvement. A chest US evaluation was limited. Chest MRI (fig. 2) revealed the "atelectatic" RLL to be the liver, raising the suspicion for CDH. Thorascopic evaluation revealed instead a diaphragmatic eventration, for which a plication procedure was done.

DISCUSSION: Diaphragmatic eventration is associated with various degrees of pulmonary hypoplasia due to the compression of the developing lung by the abdominal viscera. Respiratory distress is the most common clinical manifestation. However, findings vary on the extent of the anomaly. Patients are asymptomatic with minor anomalies, whereas extensive anomalies in neonates can cause respiratory distress (2). Our patient initially had respiratory distress related to prematurity which resolved. Re-onset of respiratory distress was due to a large right side diaphragmatic eventration that allow compression by the liver and not due to lung hypoplasia. Uniqueness of this case are the delayed presentation of a large right side eventration, not associated with pulmonary hypoplasia, misdiagnosed by MRI as CDH, and repaired thoracoscopically in 2 months old preterm infant.

CONCLUSIONS: Eventration must be considered in the differential diagnosis of a newborn with respiratory symptoms and the CXR image suggestive of lower lobe infiltrate. Symptoms of diaphragmatic eventration can be misleading which represents a diagnostic dilemma despite a proper evaluation. In these cases with delayed presentation, the prognosis tends to be better due to absent/minimal lung hypoplasia.

Reference #1: Kansal AP, Chopra V, Chahal AS, Grover CS, Singh H, Kansal S. Right-sided diaphragmatic eventration: A rare entity. Lung India. 2009;26:48-50.

Reference #2: Deslauriers J. Eventration of the diaphragm. Chest Surg Clin N Am 1998; 8:315.

DISCLOSURE: The following authors have nothing to disclose: John Bishara, Sathyaprasad Burjonrappa, Melodi Pirzada, Claudia Halaby

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