Xiaofeng Hu at Department of Radiology, Anhui Provincial Hospital, Hefei, China, and colleagues have reported an interesting case of a Bochdalek hernia that has appeared in Lancet.
A Bochdalek hernia also known as a posterolateral diaphragmatic or a pleuro-peritoneal hernia is a congenital diaphragmatic hernia. In the disease, there is an anatomical defect in the postero-lateral part of the diaphragm allowing abdominal viscera to herniate through into the thorax. The condition was first described by the Czech anatomist and pathologist, Vincenz Alexaner Bochdalek (1801–1883) in 1848. A bochdalek hernia is a cause of respiratory distress in the newborn baby; symptoms include cyanosis, tachycardia, and one side of the chest cavity appearing larger than the other.
According to history, a male newborn baby was delivered by cesarean section at 38 weeks’ gestational age because of a prenatal ultrasound diagnosis of a congenital diaphragmatic hernia. Shortly after delivery he was in respiratory distress and cyanotic, and unable to move freely. He was rapidly intubated and treated with high-frequency oscillatory ventilation. When he was stable, an x-ray was carried out at the bedside. This showed herniated bowel loops in the left hemithorax, displacement of the mediastinum to the contralateral side, and severely reduced lung space and unclear lung fields bilaterally.
Chest x-ray showing herniated bowel loops in the left hemithorax, displacement of the mediastinum to the contralateral side, severely reduced lung space and unclear lung fields bilaterally (A). Upper gastrointestinal tract x-ray showing the stomach and bowel loops stained with contrast in the left hemithorax (B).
A series of upper gastrointestinal x-rays, using water-soluble iodinated contrast media passed through a nasogastric catheter, were also taken to further assess the patient’s condition. The stomach and loops of bowel stained with contrast were clearly visible in the left hemithorax (figure).
The patient underwent a patch repair of the left posterolateral diaphragmatic hernia and the herniated viscera were returned to the abdominal cavity. The contents of a hernia were identified as colon, small bowel, stomach, and spleen. The patient had an uneventful post-operative period and was well at 6 months’ follow-up.
In this case, the diagnosis was a Bochdalek hernia, also known as a posterolateral diaphragmatic hernia or a pleuro-peritoneal hernia was made.
Although most of the pregnant women globally are subjected to ultrasound examinations if they present with vaginal bleeding, symptoms of an ectopic pregnancy, and any other pregnancy-related diseases at any time during the first trimester. Lung disease is only one of many causes of respiratory distress in a newborn baby; it is crucial, therefore, to determine a specific diagnosis. Radiographic findings can identify diaphragmatic paralysis, congenital pulmonary malformations, and intrathoracic space-occupying lesions, such as a pneumothorax, mediastinal masses, and congenital diaphragmatic herniae.
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