Peritoneography—diagnosis of delayed-onset right-sided diaphragmatic herinas masquerading as pleural effusion

Graviss, E R; Danis, Richard K.; Lewis, James E.; Beach, Pamela J.; Armand, E Brodeur

doi:10.1016/s0022-3476(80)80150-8

Cited by 23 publications

(6 citation statements)

References 7 publications

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“…Previous reports on diaphragmatic hernia and pleural effusion 1314 have centered on the fact that diaphragmatic hernia can resemble pleural effusion on chest roentgenogram. However, in one report 14 pleural tap did yield 30 cc of bloody fluid. In all three of the cases observed during the present study the diaphragmatic hernia was on the opposite side from the pleural effusion.…”

Section: Discussionmentioning

confidence: 92%

Pleural Effusion in the First Days of Life: A Prospective Study

et al. 1984

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In a thirty-month prospective study pleural effusions were found on chest radiographs in 33 of 1482 newborns admitted to intensive care units. Congenital heart disease was the most common cause, accounting for eleven cases. Meconium aspiration was the most common respiratory disease associated with neonatal pleural effusion. Infants whose effusions were first noted after the second day of life were likely to have heart disease (p = 0.02). Infants with moderate or large effusions were unlikely to have heart disease (p = 0.04). Prolonged pleural effusion was associated with a prolonged need for supplemental oxygen. Survivors whose effusions lasted three or more days were at increased risk for needing supplemental oxygen for more than twenty-one days (p = 0.07). The overall mortality was 48 percent (sixteen of thirty-three infants died).

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Section: Discussionmentioning

confidence: 92%

Pleural Effusion in the First Days of Life: A Prospective Study

et al. 1984

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“…The suggested pathomechanical processes do not necessarily imply that exclusively GBS could potentially be involved. However, it is remarkable that cases with late presentation of right CDH associated with a different organism have not been reported in the literature [11,32]. Furthermore, only two cases of an association between early-onset GBS infection and the much commoner left CDH could be identified in the literature although at least 80% of all CDH are left-sided [8,26,34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Right-sided CDH is thought to cause pleural effusion by obstructing the hepatic venous outflow [7]. These effusions are generally more significant than those observed in isolated GBS pneumonia [11]. Clinicians should be alerted to the fact that a sudden secondary respiratory deterioration in a newborn with GBS sepsis might be related to a lateonset CDH and this diagnosis should be excluded before inserting a chest drain to avoid hepatic or bowel injury [7].…”

Section: Discussionmentioning

confidence: 99%

Late-onset right-sided diaphragmatic hernia in neonates - case report and review of the literature

Strunk¹,

Simmer

Kikiros

et al. 2007

Eur J Pediatr

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An association between early-onset neonatal Group B streptococcal (GBS) sepsis and subsequent diagnosis of late-onset diaphragmatic hernia has been reported. We report one such case and review the literature. The index case involved a male preterm neonate in whom late-onset right diaphragmatic was diagnosed on day 21 following early-onset GBS sepsis. Our literature review identified 40 cases of such an association. The typical description involves near term male neonates, who improved from an early-onset GBS sepsis only to have a secondary respiratory deterioration leading to the diagnosis of late-onset right diaphragmatic hernia. With surgical repair, this condition has an excellent survival rate. In conclusion, the pathophysiological mechanisms underlying the association remain to be elucidated. Awareness of the associated pleural effusion is important to avoid inadvertent organ injury due to chest drains.

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“…Various other imaging modalities have been proposed and utilized in the diagnosis of late-presenting CDH, especially on the right side [5,11,12]. Pneumoperitoneography and contrast peritoneography have been used; these methods, however, are invasive and associated with the potential risk of complications.…”

Section: Discussionmentioning

confidence: 99%

“…The radiologic findings on plain chest radiograph in some children with staphylococcal pneumonia, lung abscess, and cystic bullae of the lung may be quite similar to those seen in cases of CDH [7]. In addition, many cases of late-presenting CDH have been initially misdiagnosed as pneumonia, pleural effusion, and pneumothorax [1,2,5,9,10,13]. Although the clinical course and general condition of children with staphylococcal pneumonia are often distinctive, it may be difficult to differentiate radiologically between a primary pulmonary disease process Correspondence to: R. B. Hirschl, University of Michigan Pediatric Surgery Associates, L2110 Women's Hospital, Box 0245, Ann Arbor, MI 48109, USA and late-presenting CDH.…”

Section: Introductionmentioning

confidence: 99%

Resolving cavitary pnemonia presenting as late-onset congenital diaphragmatic hernia

et al. 1994

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An unusual case of resolving left lower lobe pneumonia associated with pleural effusion is reported. The plain radiographs and chest CT were initially misinterpreted as showing a late-presenting congenital diaphragmatic hernia (CDH). This case illustrates that misleading radiologic assessments may occur in children with resolving pneumonia and that upper or lower gastrointestinal contrast studies should be a part of the diagnostic work-up of any case of suspected late-presenting CDH.

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Peritoneography—diagnosis of delayed-onset right-sided diaphragmatic herinas masquerading as pleural effusion

Cited by 23 publications

References 7 publications

Pleural Effusion in the First Days of Life: A Prospective Study

Pleural Effusion in the First Days of Life: A Prospective Study

Late-onset right-sided diaphragmatic hernia in neonates - case report and review of the literature

Resolving cavitary pnemonia presenting as late-onset congenital diaphragmatic hernia

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