Baby presented with tachypnoea

Wednesday, April 7, 2010
This is a Supine  Xray of a This 2 month old male baby presented with tachypnoea who was brought  to the paediatric ward by  his parents.On examination it was found to have that the child was cyanotic.


Identify this Xray??

ANSWER

ANSWER - RIGHT SIDED CONGENITAL DIAPHRAGMATIC HERNIA with Mediastinal shift


It is a congenital malformation of the diaphragm. The most common type of CDH is a Bochdalek hernia; other types include Morgagni's hernia, diaphragm eventration and central tendon defects of the diaphragm. Malformation of the diaphragm allows the abdominal organs to push into the chest thereby impeding proper lung formation.


CDH is a life-threatening pathology in infants, and a major cause of death due to two complications: pulmonary hypoplasia and pulmonary hypertension.


Newborns with CDH often have severe respiratory distress which can be life-threatening unless treated appropriately.


Congenital diaphragmatic hernia occurs 1 in 2200 births.


It occurs more commonly on the left than the right (5:1).

Clinical Presentation
The affected baby, if not diagnosed prenatally, usually presents with respiratory distress between 12 and 24 hours after birth. Other classical signs include:
A scaphoid abdomen
Hyperexpanded chest
Cyanosis
Mediastinal shift to the opposite side


Diagnosis
The majority of diaphragmatic hernia are detected antenatally
Postnatally the diagnosis is confirmed by chest radiology, which shows loops of bowel, or other abdominal viscerae, in the thorax.
Delayed X-ray following administration of contrast via the nasogastric tube shows loops of bowel in the hemithorax, confirming the congenital diaphragmatic hernia


DDx - cystic adenomatoid malformation of the lung


Treatment
Stabilization before surgery- nasogastric aspiration, ventilation and bicarbonate infusion to correct acid-base and blood gas abnormalities


Reduction of abdominal contents and repair of the residual diaphragm with non-absorbable sutures


Postoperative ventilation and early oral feeding are recommended


Prognosis
The overall mortality is 50 to 60%
A good prognostic indicator is the position of the stomach; if it remains in the abdomen the prognosis is good; if it is in the chest the prognosis is poor.
Death is secondary to pulmonary hypoplasia.

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22 comments

  1. Anonymous Says:
  2. TOF most probably

     
  3. Anonymous Says:
  4. cavitation

     
  5. GIANNI Says:
  6. cystic adenomatoid malformation

     
  7. Anonymous Says:
  8. rt sided pneumonia( aspiration)

     
  9. Anonymous Says:
  10. right sided congenital diaphragmatic hernia

     
  11. Litzi Says:
  12. diaphragmatic hernia

     
  13. Anonymous Says:
  14. righ sided diaphramatic hernia

     
  15. saifalddin Says:
  16. ASD

     
  17. fouzia Says:
  18. diaphragmetic hernia

     
  19. Anonymous Says:
  20. TOF or right sided diaphragmatic hernia

     
  21. falat Says:
  22. diaphragmatic hernia

     
  23. Anonymous Says:
  24. diaphragmatic hearnia

     
  25. dr. niveen Says:
  26. rt side diaphragmatic hernia with rt side lung collapse with mediastinal shift to lt side

     
  27. Anonymous Says:
  28. bochdalek hernia.

    Levent from turkey

     
  29. Anonymous Says:
  30. Diaphragmatic Hernia
    Sadaf

     
  31. Manan Says:
  32. TOF most likely

     
  33. Anonymous Says:
  34. Right Diaprhagmatic hernia

    Dr Mritunjay Pao

     
  35. Anonymous Says:
  36. is that the ng tube centrally located guys?
    it gives some clue........think
    basik

     
  37. Anonymous Says:
  38. Coarctation of aorta or TOF

     
  39. Anonymous Says:
  40. RSV??

     
  41. Anonymous Says:
  42. diaphragmetic hernia

     
  43. Anonymous Says:
  44. right sided diaphragmatic hernia

     

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