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Thoracoscopic repair of diaphragmatic eventration.

We report a 6-month-old child who presented with recurrent chest infections associated with a right diaphragmatic eventration. Failure in conservative management lead to thoracoscopic plication at 17 months of age and discharge on the third postoperative day. At one year followup he is completely free from all symptoms, and his chest x-ray demonstrates a marked improvement in the position of the diaphragm. We recommend thoracoscopy as a viable approach in treating this condition in children.

Diaphragmatic Eventration↗

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.

Child↗

[Diaphragmatic eventration and paralysis in children].

Diaphragmatic relaxation is either congenital, due to muscular dysplasia ("eventration"), or acquired and related to phrenic nerve lesion ("paralysis"); phrenic nerve paralysis can be a complication of a difficult delivery (breech presentation or forceps) or of a surgical--mostly cardiac--procedure. The authors review their own experience (12 eventrations and 9 paralysis) and recall the pathophysiology, the symptoms and treatment of this condition. They recommend the surgical plication, as most experienced authors do, when the symptoms are not completely alleviated by medical treatment which should be of short duration and must include intubation and assisted ventilation in case of acute respiratory distress.

Diaphragm↗

Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review.

Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral. Although this entity is frequently asymptomatic and firstly detected on the chest radiography, it may be difficult to distinguish a partial eventration from the other diaphragmatic lesions or mediastinal pathologies on the chest radiographs. US may present valuable information about diaphragm integrity with eventration content or the other diaphragmatic pathologies. Although the other imaging modalities such as fluoroscopy, computed tomography, and MR imaging may be performed as adjunct techniques in cases of the diagnosis still in doubt, they are frequently unnecessary after US. Our goal is to present imaging features and management of this entity together with a literature review.

Diagnosis, Differential↗

Beta haemolytic streptococcal infection does not cause right diaphragmatic eventration.

Numerous case reports in the literature have suggested a causal link between beta-haemolytic streptococcal infection and delayed-onset right-sided diaphragmatic hernia/eventration in the perinatal age group. 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.

Abnormalities, Multiple↗

[Diaphragmatic eventration with paroxysmal supraventricular tachycardia; report of a case].

A 68-year-old man visited our hospital complaining of chest discomfort and palpitation and was hospitalized under the diagnosis of diaphragmatic eventration. The chest X-ray showed an elevated left hemidiaphragm including air bubbles. The chest computed tomography (CT) and magnetic resonance imaging (MRI) showed a very high position of the left hemidiaphragm and displacement of the abdominal organs into the left thoracic cavity. The Holter electrocardiogram showed paroxysmal supraventricular tachycardia. The procedure was performed under video-assisted thoracoscopic surgery with a minithoracotomy (7 cm) in the 8th intercostal space. The left diaphragm appeared loose and reduced in thickness, the diaphragm was incised and longitudinal plication 12cm in diameter was accomplished with a series of U-stitches with Teflon-felt. Furthermore, the suture line was reinforced by prolene mesh. Postoperative course was uneventful, and the chest symptom and arrhythmia were resolved immediately.

Aged↗

Technique for the repair of diaphragmatic eventration.

In contrast to the large thoracotomy incisions required by standard surgical techniques for repair of diaphragmatic eventration, the procedure we developed can be performed by video-assisted thoracoscopy, thus offering patients the advantages of a minimally invasive operation. Using two superposed series of transverse back-and-forth continuous sutures, the diaphragm is invaginated, then stretched. The first suture line holds the diaphragm down and maintains the excess within the abdomen; the second suture line places the desired tension on the diaphragmatic dome. Successful repair of 3 cases by this technique is described.

Adult↗

An autopsy case of caudate nucleus lobulation accompanied with diaphragmatic eventration.

We describe an autopsy female case of multiple anomalies with lobulation of caudate nucleus tail, diaphragmatic eventration, skeletal anomalies, pyramidal tract anomaly, and meningothelial meningioma. Her psychomotor development was delayed, and she developed bilateral eventration of the diaphragms on X-ray film in her third decades. Right hemi-colonectomy was performed for volvulus at the age of 44 years, and meningioma was incidentally identified. She died at the age of 47 years. Autopsy demonstrated the partial deficiency of the muscular tissue in the circular thinned membranous area predominantly on left side including the central tendon of the diaphragm. The tails of the bilateral caudate nucleus demonstrated excessive lobulations, and the brainstem pyramidal tract showed hypoplasia. Immunoreactivity for tyrosine hydroxylase was deficient in the lobulated tail of caudate. We believe that this case is characterized by a rare combination of eventration, skeletal and nervous anomalies.

Abnormalities, Multiple↗

Surgical correction of hydrothorax from diaphragmatic eventration in children on peritoneal dialysis.

Continuous ambulatory peritoneal dialysis (CAPD) is frequently used in the pediatric age group for reversible and end-stage renal failure. Most pediatric patients tolerate this therapy with few complications. Approximately 2% of children, however, develop massive unilateral hydrothorax. This major complication usually results in the discontinuation of peritoneal dialysis in all forms and the institution of hemodialysis. Occult diaphragmatic defects account for most adult and pediatric patients who develop this complication. Three pediatric patients receiving CAPD complicated by massive hydrothorax are described. All patients were successfully treated by thoracotomy and repair of the diaphragmatic eventration with an immediate return to CAPD. This is the first report of successful therapy of this kind in children. A review of the cause, diagnosis, and treatment of massive hydrothorax developing during CAPD therapy is presented.

Child, Preschool↗