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Diaphragmatic eventration in the adult may be associated with dyspnoea. Video-assisted thoracoscopic surgery (VATS) techniques have been applied to the plication of diaphragmatic eventration in three adult patients. Symptoms and spirometry improved in all patients. Ventilation and perfusion of the affected lung was also improved.
The pathology of a horse is described, in which thoracic trauma with costal fracture and a small diaphragmatic defect later led to entrapment of small intestine in the thorax.
Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm resulting from failure of muscle fibers to develop during gestation. 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. Differentiating between congenital diaphragmatic eventration and congenital diaphragmatic hernia is very difficult but important because eventration has a better perinatal outcome than diaphragmatic hernia has. This report discusses a case of congenital diaphragmatic eventration that was initially diagnosed by prenatal sonography as a diaphragmatic hernia on the left side. In this case, the correct diagnosis was made at the time of surgery shortly after the infant's birth. The defect was repaired by plication, and the infant's outcome was favorable. Although the initial diagnosis was incorrect in this case, the use of sonography can aid in the prenatal detection and diagnosis of congenital diaphragmatic anomalies.
Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) still have high mortality. Our aims were to identify clinical prognostic factors for CDH and SDE, and to determine whether the size or area of the proximal bilateral pulmonary arteries (PA) correlate with the clinical outcome. We retrospectively analyzed medical charts of 26 patients--20 with CDH and 6 with SDE, but no obvious other associated anomalies--admitted over a 12-year period. We compared prenatal history, clinical manifestations, blood gas, and echocardiography before surgery in the survivors and the non-survivors. Ten patients (8 CDH, 2 SDE) died 2 to 16 days after birth, including 2 patients without surgery due to progressive hypoxemia. The survivors had significantly higher 1- and 5-min Apgar scores, higher the worst preductal arterial blood gas pH levels, lower oxygen indices, and lower PaCO2 (P < 0.05). The McGoon index of PA size measured by echocardiography was higher in survivors, but not statistically significant. Nakada PA index results, however, were statistically significant (93.07 +/- 32.02 vs. 121.07 +/- 27.08, P < 0.05) In conclusion, Apgar scores, preductal PaCO2, oxygen index, and pH level can predict prognosis in infants with CDH and SDE. The Nakada PA index, however, might be a useful prognostic marker for patients with CDH and SDE.
Partial diaphragmatic eventration, when occurring at uncommon sites, is difficult to diagnose when only using a plain X-p and fluoroscopy. We experienced an unusual variety of this disorder. In order to diagnose this case, liver scintigraphy using 99mTc-phytate was performed, and we were able to make a definite diagnosis without other invasive examinations.
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Diaphragmatic eventration is a rare abnormality, which has the similar ultrasonographic features to congenital diaphragmatic hernia. Therefore, these two diseases are difficult to differentiate from each other prenatally. We present here a case in which the presence of congenital diaphragmatic eventration was strongly suggested by magnetic resonance imaging (MRI) and ultrasonography. A 26-year-old pregnancy woman, gravida 0, para 0, week 35, was admitted to our hospital with an ultrasonographic abnormality of the fetal thorax. MRI and ultrasonography showed interesting features which strongly suggested the presence of congenital diaphragmatic eventration and helped to differentiate it from congenital diaphragmatic hernia.
We describe an infant with severe eventration of the right diaphragm and pulmonary hypoplasia who presented like a newborn with congenital diaphragmatic hernia complicated by persistent pulmonary hypertension. Surgical correction while on extracorporeal life support was unsuccessful due to attachments of the liver which prevented reduction into the abdominal cavity and our inability to distinguish the true defect from complete agencies of the right hemidiaphragm. At autopsy the pulmonary remnant and the fibrous membrane separating it from the liver were identified.
Surgical intervention of diaphragmatic eventration is urgent and life-saving in infants but is rarely in adults. In the past 22 years, Seven adults with diaphragmatic eventration were encountered at the Division of thoracic surgery, Dept. of surgery, VGH, Taipei. The age on diagnosis ranged from 32 to 65 years with mean of 44 years old. Male and left diaphragm were more frequently affected (6 men, 1 woman; 6 left, 1 right). All of them received operation of plication. In spite of good immediate postoperative return of the diaphragms to normal position with clinical improvement found in all patients, 5 dyspneic patients were found to have gradual diaphragmatic rise or relapse of respiratory symptoms after repair. Diaphragmatic eventration could cause compression of lung by abdominal organs and reinforcement of diaphragm through plication might increase the diaphragm strength and diminish the clinical symptoms. Yet according to our series, we recommend surgical intervention is only for existence of distress stemmed from it and unresponsive to medical therapy.
Diaphragmatic eventration is the upward displacement of the abdominal viscera secondary to a thin or paralytic diaphragm. Its clinical presentations and radiographic pictures are similar to those of diaphragmatic hernia. Prenatal diagnosis of diaphragmatic eventration is extremely rare. A pregnant woman was referred to us because of abnormal cardiac findings noted at 20 weeks of gestation. A diagnosis of partial anomalous pulmonary venous connection was made on the basis of our findings of right atrial enlargement with an abnormal vascular channel drainage to it. The infant was born via cesarean section at 40 weeks and developed complications of cyanosis immediately after birth. Postnatal imaging studies and surgical findings disclosed right side diaphragmatic eventration with liver and associated vasculature upward displacement into the right pleural cavity. The cardiac structure was otherwise normal. We conclude that when an abnormal vessel tracing and unexplainable cardiac chamber asymmetry is encountered, diaphragmatic eventration should be considered as one of the differential diagnoses. Correct recognition and transferral to the hospital for neonatal assistance may lead to timely and appropriate management of these fetuses.
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.
BACKGROUND: Diaphragmatic eventration is a rare cause of respiratory distress and failure to thrive in children. METHOD/RESULT: A report of a case of diaphragmatic eventration in a four-month-old child is presented with a review of the relevant literature. CONCLUSION: Clinicians should be aware of this diagnosis and avoid misdiagnosing the condition as a diaphragmatic hernia.
Three patients with congenital diaphragmatic eventration have been reported. The diagnosis was established by chest radiography which showed an abnormally elevated diaphragm. Additionally fluoroscopy, ultrasonography and pulmonary function tests were used. Diaphragmatic plication was performed in order to restore normal pulmonary parenchymal volume and the diaphragm was replaced in its normal localization. All the patients had been discharged in good condition following uneventful postoperative courses. In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.
Diaphragmatic eventration is the abnormal elevation of the diaphragm as a result of paralysis, aplasia or atrophia of the muscular fibers. This is a diagnostic problem specially in the newborn. The objective of this report is present the clinical course and surgical management of 50 cases attended in the Hospital Infantil de México Federico Gómez. Of them, 56% were males; eight were newborns; five with previous surgery. The clinical course was variable; the landmark was the chest X-ray findings. There were operated 36 cases. The right diaphragm was the most frequent affected; the surgical management was with thoracotomy in the great majority of them. In 30 cases had good evolution two years after surgery.
PURPOSE: The purpose of this study is to examine the justification of diaphragmatic plication to treat diaphragmatic eventration. A retrospective review of 50 patients who underwent diaphragmatic plication for phrenic nerve injury (PNI) or congenital muscular deficiency (CMD) of the diaphragm was conducted. METHODS: During the last 26 years, 50 patients, aged 4 days to 7 years, were surgically treated for diaphragmatic eventration. Twenty-five patients had iatrogenic PNI and another 25 had CMD. Respiratory distress developed in all patients who had PNI and 10 required mechanical ventilatory support for 13 to 78 days (mean, 41 days) before operation. Respiratory symptoms developed in 17 of 25 patients who had CMD, and four required ventilatory support. In those who were asymptomatic, we justified surgical repair to optimize future lung growth. All patients underwent diaphragmatic plication by a thoracic approach. Reefing mattress sutures on pledgets were used for the plication. RESULTS: In patients who had PNI, ventilatory support could be discontinued within 0 to 6 days (mean, 3 days) after operation, with a dramatic improvement in their respiratory status. Two patients required reoperation because the plication was not tight enough. Seven patients died in this series, but none because of the diaphragmatic plication. CONCLUSION: This study suggests that symptomatic patients who have diaphragmatic eventration should be operated on immediately with an expected dramatic resolution of their respiratory problems.
BACKGROUND AND AIM: Recent reports in literature have emphasized the clinical perception of reduced pain, postoperative morbidity, and dysfunction associated with thoracoscopic approach compared with standard thoracotomy. The authors describe a thoracoscopic approach and technical details for diaphragmatic eventration repair in children. PATIENTS AND METHODS: Ten patients, 4 girls and 6 boys, 1 teenager (14 years old) and 9 children (age range, 6-41 months; average, 17 months), were operated for a diaphragmatic eventration in 3 different pediatric surgery teams, according to the same technique. Symptoms were recurrent infection (7 cases), dyspnea on exertion (2 cases), and a rib deformity (1 case). An elective thoracoscopy was performed, patient in a lateral decubitus. A low carbon dioxide insufflation allowed a lung collapse. Reduction of the eventration was made progressively when folding and plicating the diaphragm. Plication of the diaphragm was done with an interrupted suture (6 cases) or a running suture (4 cases). The procedure finished either with an exsufflation (4 cases) or a drain (6 cases). RESULTS: A conversion was necessary in 2 cases: 1 insufflation was not tolerated and 1 diaphragm, higher than the fifth space, reduced too much the operative field. Patients recovered between 2 and 4 days. Dyspnea disappeared immediately. Mean follow-up of 16 months could assess the clinical improvement in every patient. DISCUSSION: Thoracoscopic conditions are quite different between a diaphragmatic hernia repair previously reported and an eventration. Concerning diaphragmatic hernias, reduction is easy, giving a large operative space for suturing the diaphragm. Concerning diaphragmatic eventrations, the lack of space remains important at the beginning of the procedure despite the insufflation into the pleural cavity. The operative ports must be high enough in the chest to allow a good mobility of the instruments. Chest drainage seems to be unnecessary. CONCLUSION: Diaphragmatic eventration repair by thoracoscopy is feasible, safe, and efficient in children. Above all, it avoids a thoracotomy. It improves the immediate postoperative results with a good respiratory function.
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