Elevation of diaphragmatic crus, and diaphragmatic eventration. Mesh placement on the hemidiaphragm fixed in the anterolateral position. Bilaterally, hypoplastic femoral region being less severe at lower femoral region was observed. The pleural effusion through the chest tube was high and remained constant in the first 4 weeks and decreased 2 weeks later, after which we had removed the thoracic tube. Cardiopulm Phys Ther J. The clinical features included dry cough, chest pain, respiratory distress, and bronchial spasms for 4 years; additionally, the patient had episodes of bronchial asthma since her childhood. Contrast coronal section showing both hemithoraces.
Among minimally invasive surgical techniques, diaphragmatic plication has established its success as a very effective method with lower morbidity 1- 3,5,6. In this patient, she presented with symptoms similar to diaphragmatic hernia, thus a combination of imaging modalities help in the diagnosis in this patient. Incision of the laminated and elongated hemidiaphragm with the presence of muscle fibers. Delos Santons MD— data analysis and interpretation. Axial view of the Chest CT-scan IV and oral contrast showing gastric and bowel contents in the left hemithorax. Published online Apr Congenital diaphragmatic eventeration in an adult:
Chest Xray taken 1 week post-operatively showing left lung expansion and elevated left hemidiaphragm.
Elevation of diaphragmatic crus, and diaphragmatic eventration. The etiology of renal ectopia can encompass infectious problems such as schistosomiasis or pathologies prevalent in northern Peru, such as malaria [ 919 ].
Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation
Central trachea and normal left hemithorax. But we still recommend surgery once diagnosis is confirmed if not for vase lung mechanics but to prevent other complications such as gastric volvulus.
Diaphragmatic eventration is a rarely seen asymptomatic pathology, which is generally diagnosed incidentally On gross examination examination at autopsy, his heart gleft gand right g lungs, and liver g weighed as indicated. We aimed to discuss rarely encountered diaphragmatic eventration in autopsy practice from a perspective of forensic me dicine.
As reported by his family, our old male patient who was found dead at home, had suffered from poliomyelitis when he was a child, and also treated for respiratory tract diseases. Congenital diaphragmatic even tration is characterized by aplasia of the diaphragm muscle 2. In asymptomatic patients, there are no data comparing the surgical treatment and the conservative approach or the adequate surgical time from the onset of symptoms, especially in the group with phrenic nerve injury; patients with phrenic injury after cardiac surgery may show improvement in the first or second year.
Paresis or diaphragmatic paralysis is an acquired condition resulting from certain abnormalities that affect the neuromuscular axis between the cervical spinal cord and the diaphragm.
Case Reports in Surgery
Patient had an unremarkable post-operative stay with resolution of symptoms. We proceeded by performing posterolateral thoracotomy at the level of the seventh intercostal space, with the hemidiaphragm incision to visualize the peritoneal viscera and avoid injury. It is possible to show uninterrupted continuity of the diaphragm to differentiate eventration from hernia, diaphrxgmatic fact that determines the surgical criteria in case the patient is asymptomatic.
Acquired diaphragmatic eventration can be caused by phrenic nerve injury resulting in diaphragmatic elevation, and paralysis.
Forensic medicine doctors should investigate diaphragmatic lesions properly during their autopsy practices in order to aid in the detection diapbragmatic cause of death and also development of new management strategies for understanding different diaphragmatic pathologies.
Plication is indicated if there are symptoms of dyspnea which can be due to decrease ventilation and oxygenation because of paradoxical motion of the affected diaphragm during inspiration and expiration.
The embryological mechanism is not clear. Chest X-ray showed the presence of bowel loops in the left thorax and the cardiac shadow shifted to the right. Bowel loops can be seen in the thorax if a radiopaque contrast agent is used [ 10 ]. The cases reported previously have casw associated with congenital diaphragmatic hernia but have not been associated with diaphragmatic eventration, as seen in our case.
Physical examination showed bowel sound involving the left hemithorax. Author information Article notes Copyright and License information Disclaimer.
Chest Xray AP view showing shift of the cardiac shadow to the right with note of bowel loops in the left thorax. Delos Santons MD— data analysis and interpretation. The aim of surgical repair is to place the diaphragm in a position of maximum inspiration which relieves compression on the diapgragmatic parenchyma and allows its re-expansion. Patient had no previous history of trauma.
Diaphragmatic Eventration: Autopsy Case Report
Its unbroken continuity differentiates it from diaphragmatic hernia . Among symptomatic patients, the most common symptom is dyspnea. Patient underwent plication of the diaphragm using the abdominal approach. Discussion Management of diaphragmatic eventeration varies greatly on the symptoms of the patients.
The right kidney and its respective pedicle in the posterior intrathoracic situation. A evenration thoracotomy was continued at the level of the seventh intercostal space, with the hemidiaphragm being thinned, although with moderate thickness of muscle fibers Figure 8.