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Giant congenital diaphragmatic hernia in an adult.

Zhou Y, Du H, Che G - J Cardiothorac Surg (2014)

Bottom Line: It appears frequently in infants but rarely in adults.We present the case of a 50-year-old female han patient with tremendous left-sided congenital posterolateral diaphragmatic hernia (Bochdalek hernia) who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lower-left lobe.The patient had an experience of misdiagnosis and she was treated for bronchitis for one year until being admitted to our hospital.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan, Province, PR China. cheguowei_hx@aliyun.com.

ABSTRACT
Bochdalek hernia is the most common type of congenital diaphragmatic hernia. It appears frequently in infants but rarely in adults. We present the case of a 50-year-old female han patient with tremendous left-sided congenital posterolateral diaphragmatic hernia (Bochdalek hernia) who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lower-left lobe. The patient had an experience of misdiagnosis and she was treated for bronchitis for one year until being admitted to our hospital. This case study emphasizes the rare presentation of Bochdalek hernia in adults and the necessity of high clinical attention to similar cases.

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MPRs showed the left thoracic cavity was completely filled with abdominal organs reaching to the apex of the pleura cavity and the interrupted hemidiaphragm of Bochdalek hernia (the arrowhead).
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Figure 1: MPRs showed the left thoracic cavity was completely filled with abdominal organs reaching to the apex of the pleura cavity and the interrupted hemidiaphragm of Bochdalek hernia (the arrowhead).

Mentions: A 50-year-old female patient of Han nationality was admitted to our department with a one year history of slight dyspnea. The discomfort was greatly obvious after heavy physical work, but could be alleviated by taking a rest. She denied having other symptoms such as chest pain, abdominal pain, dysphagia, vomiting, and dyspepsia. There was no history of trauma or surgery. Upon physical examination we inspected nothing characteristic except the remarkable decrease of breathing sounds and increased bowel sounds in the left hemithorax. Contrast-enhanced chest computed tomography(CT) and multiplanar reconstructions(MPRs) showed a notable displacement of the abdominal viscera into the left thoracic cavity and the interrupted hemidiaphragm [Figure 1]. The atelectasis of the left lung was serious for most of the whole left thoracic cavity was filled by the atopic abdominal organs. The heart was also extruded into the right hemithorax and the right lung was partially compressed [Figure 2]. As the preoperative diagnosis that is a left-sided diaphragmatic hernia made, the patient was taken in for surgery. Under general anesthesia using a double- lumen tube, a standard posterolateral thoracotomy entering the chest through the seventh intercostal space was made. During the operation, it was found that most of the left thoracic cavity was filled with abdominal organs reaching to the apex of the pleural cavity. When the exploration of the thoracic cavity was performed, we found the stomach, small bowel loops, omentum and a partial transverse colon. There was no remarkable adhesion except around the hernial sac. After reducing the abdominal organs, a defect located on the left posterolateral side of the hemidiaphragm and measuring approximately 10*8 cm became visible. We also found that the left upper and lower lobes were subtotally atelectatic. The defect was primarily repaired by a Dacron patch and was sutured with a non-absorbable monofilament [Figure 3]. The procedure was ended with the left thoracic cavity drained by a single chest tube(28 F). After the surgery we diagnosed the patient had a left-sided Bochdalek hernia. In the post-op period, the patient had an uneventful and smooth recovery. A repeated chest radiograph after 4 days of surgery revealed that the re-expansion of the left lung went very well [Figure 4]. She was discharged home without any respiratory or gastrointestinal symptoms.


Giant congenital diaphragmatic hernia in an adult.

Zhou Y, Du H, Che G - J Cardiothorac Surg (2014)

MPRs showed the left thoracic cavity was completely filled with abdominal organs reaching to the apex of the pleura cavity and the interrupted hemidiaphragm of Bochdalek hernia (the arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3924702&req=5

Figure 1: MPRs showed the left thoracic cavity was completely filled with abdominal organs reaching to the apex of the pleura cavity and the interrupted hemidiaphragm of Bochdalek hernia (the arrowhead).
Mentions: A 50-year-old female patient of Han nationality was admitted to our department with a one year history of slight dyspnea. The discomfort was greatly obvious after heavy physical work, but could be alleviated by taking a rest. She denied having other symptoms such as chest pain, abdominal pain, dysphagia, vomiting, and dyspepsia. There was no history of trauma or surgery. Upon physical examination we inspected nothing characteristic except the remarkable decrease of breathing sounds and increased bowel sounds in the left hemithorax. Contrast-enhanced chest computed tomography(CT) and multiplanar reconstructions(MPRs) showed a notable displacement of the abdominal viscera into the left thoracic cavity and the interrupted hemidiaphragm [Figure 1]. The atelectasis of the left lung was serious for most of the whole left thoracic cavity was filled by the atopic abdominal organs. The heart was also extruded into the right hemithorax and the right lung was partially compressed [Figure 2]. As the preoperative diagnosis that is a left-sided diaphragmatic hernia made, the patient was taken in for surgery. Under general anesthesia using a double- lumen tube, a standard posterolateral thoracotomy entering the chest through the seventh intercostal space was made. During the operation, it was found that most of the left thoracic cavity was filled with abdominal organs reaching to the apex of the pleural cavity. When the exploration of the thoracic cavity was performed, we found the stomach, small bowel loops, omentum and a partial transverse colon. There was no remarkable adhesion except around the hernial sac. After reducing the abdominal organs, a defect located on the left posterolateral side of the hemidiaphragm and measuring approximately 10*8 cm became visible. We also found that the left upper and lower lobes were subtotally atelectatic. The defect was primarily repaired by a Dacron patch and was sutured with a non-absorbable monofilament [Figure 3]. The procedure was ended with the left thoracic cavity drained by a single chest tube(28 F). After the surgery we diagnosed the patient had a left-sided Bochdalek hernia. In the post-op period, the patient had an uneventful and smooth recovery. A repeated chest radiograph after 4 days of surgery revealed that the re-expansion of the left lung went very well [Figure 4]. She was discharged home without any respiratory or gastrointestinal symptoms.

Bottom Line: It appears frequently in infants but rarely in adults.We present the case of a 50-year-old female han patient with tremendous left-sided congenital posterolateral diaphragmatic hernia (Bochdalek hernia) who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lower-left lobe.The patient had an experience of misdiagnosis and she was treated for bronchitis for one year until being admitted to our hospital.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, Sichuan, Province, PR China. cheguowei_hx@aliyun.com.

ABSTRACT
Bochdalek hernia is the most common type of congenital diaphragmatic hernia. It appears frequently in infants but rarely in adults. We present the case of a 50-year-old female han patient with tremendous left-sided congenital posterolateral diaphragmatic hernia (Bochdalek hernia) who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lower-left lobe. The patient had an experience of misdiagnosis and she was treated for bronchitis for one year until being admitted to our hospital. This case study emphasizes the rare presentation of Bochdalek hernia in adults and the necessity of high clinical attention to similar cases.

Show MeSH
Related in: MedlinePlus