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Diaphragmatic eventration in the adult may be associated with dyspnoea. Video-assisted thoracoscopic surgery (VATS) techniques have been applied to the plication of diaphragmatic eventration in three adult patients. Symptoms and spirometry improved in all patients. Ventilation and perfusion of the affected lung was also improved.
The pathology of a horse is described, in which thoracic trauma with costal fracture and a small diaphragmatic defect later led to entrapment of small intestine in the thorax.
Partial diaphragmatic eventration, when occurring at uncommon sites, is difficult to diagnose when only using a plain X-p and fluoroscopy. We experienced an unusual variety of this disorder. In order to diagnose this case, liver scintigraphy using 99mTc-phytate was performed, and we were able to make a definite diagnosis without other invasive examinations.
Diaphragmatic eventration is a rare abnormality, which has the similar ultrasonographic features to congenital diaphragmatic hernia. Therefore, these two diseases are difficult to differentiate from each other prenatally. We present here a case in which the presence of congenital diaphragmatic eventration was strongly suggested by magnetic resonance imaging (MRI) and ultrasonography. A 26-year-old pregnancy woman, gravida 0, para 0, week 35, was admitted to our hospital with an ultrasonographic abnormality of the fetal thorax. MRI and ultrasonography showed interesting features which strongly suggested the presence of congenital diaphragmatic eventration and helped to differentiate it from congenital diaphragmatic hernia.
We describe an infant with severe eventration of the right diaphragm and pulmonary hypoplasia who presented like a newborn with congenital diaphragmatic hernia complicated by persistent pulmonary hypertension. Surgical correction while on extracorporeal life support was unsuccessful due to attachments of the liver which prevented reduction into the abdominal cavity and our inability to distinguish the true defect from complete agencies of the right hemidiaphragm. At autopsy the pulmonary remnant and the fibrous membrane separating it from the liver were identified.
Surgical intervention of diaphragmatic eventration is urgent and life-saving in infants but is rarely in adults. In the past 22 years, Seven adults with diaphragmatic eventration were encountered at the Division of thoracic surgery, Dept. of surgery, VGH, Taipei. The age on diagnosis ranged from 32 to 65 years with mean of 44 years old. Male and left diaphragm were more frequently affected (6 men, 1 woman; 6 left, 1 right). All of them received operation of plication. In spite of good immediate postoperative return of the diaphragms to normal position with clinical improvement found in all patients, 5 dyspneic patients were found to have gradual diaphragmatic rise or relapse of respiratory symptoms after repair. Diaphragmatic eventration could cause compression of lung by abdominal organs and reinforcement of diaphragm through plication might increase the diaphragm strength and diminish the clinical symptoms. Yet according to our series, we recommend surgical intervention is only for existence of distress stemmed from it and unresponsive to medical therapy.
Unilateral diaphragmatic eventration and paralysis require plication in cases of progressive dyspnea on exertion and recurrent respiratory infection. The patient, a 40-year-old woman, who had complained of worsening dyspnea on exertion and elevation of the left diaphragm on chest radiographs for 4 years, underwent plication by thoracoscopy with knifeless endostaplers. Improvements in pulmonary functions and dyspnea on exertion have been maintained for 14 months.
Three patients with congenital diaphragmatic eventration have been reported. The diagnosis was established by chest radiography which showed an abnormally elevated diaphragm. Additionally fluoroscopy, ultrasonography and pulmonary function tests were used. Diaphragmatic plication was performed in order to restore normal pulmonary parenchymal volume and the diaphragm was replaced in its normal localization. All the patients had been discharged in good condition following uneventful postoperative courses. In this study we discussed the etiology, diagnosis, treatment and postoperative courses of diaphragmatic eventration.
Diaphragmatic eventration is the abnormal elevation of the diaphragm as a result of paralysis, aplasia or atrophia of the muscular fibers. This is a diagnostic problem specially in the newborn. The objective of this report is present the clinical course and surgical management of 50 cases attended in the Hospital Infantil de México Federico Gómez. Of them, 56% were males; eight were newborns; five with previous surgery. The clinical course was variable; the landmark was the chest X-ray findings. There were operated 36 cases. The right diaphragm was the most frequent affected; the surgical management was with thoracotomy in the great majority of them. In 30 cases had good evolution two years after surgery.
PURPOSE: The purpose of this study is to examine the justification of diaphragmatic plication to treat diaphragmatic eventration. A retrospective review of 50 patients who underwent diaphragmatic plication for phrenic nerve injury (PNI) or congenital muscular deficiency (CMD) of the diaphragm was conducted. METHODS: During the last 26 years, 50 patients, aged 4 days to 7 years, were surgically treated for diaphragmatic eventration. Twenty-five patients had iatrogenic PNI and another 25 had CMD. Respiratory distress developed in all patients who had PNI and 10 required mechanical ventilatory support for 13 to 78 days (mean, 41 days) before operation. Respiratory symptoms developed in 17 of 25 patients who had CMD, and four required ventilatory support. In those who were asymptomatic, we justified surgical repair to optimize future lung growth. All patients underwent diaphragmatic plication by a thoracic approach. Reefing mattress sutures on pledgets were used for the plication. RESULTS: In patients who had PNI, ventilatory support could be discontinued within 0 to 6 days (mean, 3 days) after operation, with a dramatic improvement in their respiratory status. Two patients required reoperation because the plication was not tight enough. Seven patients died in this series, but none because of the diaphragmatic plication. CONCLUSION: This study suggests that symptomatic patients who have diaphragmatic eventration should be operated on immediately with an expected dramatic resolution of their respiratory problems.
The Authors report a case of diaphragmatic eventration associated with Wolff-Parkinson-White's syndrome. It's difficult to explain this unusual association. It's possible that the presence of cardiac accessory pathways in this particular patient is due to the alteration of the normal anatomical relationship resulting from the diaphragmatic eventration.
A case of right diaphragmatic eventration, associated with a lung sequestration, in a 7-month-old infant is presented. Failure to thrive was the initial symptom. X-ray of the chest, made because of mild respiratory distress, revealed an inhomogeneous opacification of the right lower hemithorax, suggesting a diaphragmatic hernia. A right thoracotomy was performed and a diaphragmatic eventration covered by a thick pleuroperitoneal membrane was found, together with sequestration of the lung. The pathologic findings and the embryology are discussed.
A 59-year-old woman was admitted to our hospital because of left diaphragmatic eventration due to a left phrenic nerve injury following surgery for recurrent thyroid cancer. She underwent plication by thoracoscopic surgery followed by marked expansion of the left lung and improvement of pulmonary function and dyspnea on exercise. Thoracoscopic plication for diaphragmatic eventration is a useful minimally invasive surgical technique.
Indication for surgical treatment and its results are reported in 17 consecutive cases of diaphragmatic eventration in pediatric age. Fourteen of the patients are males and 3 are females. Eleven of them had a right eventration 6 had a left eventration. Three of the patients were new-born, 13 were aged from 6 months to 3 years and 1 was aged 6 years. Two patients had gastroesophageal reflux, 1 had right intralobar pulmonary sequestration, and another had inguinal hernia. In 2 of the new-born the eventration was caused by a phrenic nerve palsy (in 1 case resulting from birth trauma, while in the other one resulting from multiple thoracentesis). In this last patient surgical treatment wasn't performed, and restitutio ad integrum was observed in 4 weeks' time. The indication for surgical treatment in 2 new-born patients was persistent polypnoea and dyspnoea unresponsive to medical treatment, in 12 of the patients were relapsing bronchitis and bronchopneumonia. Moreover 1 patient with few symptoms but with important diaphragmatic eventration was operated. In all the patients a diaphragmatic plication with fixing of the diaphragmatic plica to the ribs was performed through a thoracic approach. Neither complication or deaths were noticed. There was an immediate remission of the symptomatology in all the cases examined. No relapse of eventration or restarting of the symptomatology was found during a follow-up for a period of 2 to 8 years.
A 56-year-old woman underwent plication with U-stitches by thoracoscopic surgery for left diaphragmatic eventration. Marked improvement in left lung expansion, normalization of the position of the left diaphragm on chest radiograph, and improvement of pulmonary function and dyspnea on exertion have been maintained for 2 years. Plication for diaphragmatic eventration should be performed with minimally invasive surgery.
Two sporadic cases of eventration of the diaphragm are reported; one had bilateral colobomatous microphthalmia and the other had anophthalmia. Absence of polydactyly and presence of eventration rather than diaphragmatic hernia helped to exclude Fryns syndrome. These cases together with published cases with overlapping features support the thesis that this combination of defects is nonrandom and of heterogeneous cause. Some cases are due to a pleiotropic gene defect. In other cases, a polytypic developmental field involving an unknown developmental cascade common to the eye and diaphragm may provide a basis for the combination.
We describe a patient who presented with a left lower lobe lung lesion suspicious for cancer with possible hilar involvement. Intraoperatively, we found a primary left phrenic nerve tumor, diaphragmatic eventration, and left lower lobe atelectasis. He was successfully treated with total excision of the tumor and plication of the diaphragm. Histopathology was consistent with schwannoma of the phrenic nerve. Diaphragmatic eventration is an uncommon presentation of a phrenic nerve schwannoma, which is itself a rarely occurring tumor. Surgical resection of the tumor and diaphragmatic plication is the primary modality of management in these patients.
The authors report two cases of neonatal partial diaphragmatic eventration. The diagnosis in both two cases was echographic more than radiographic. The authors underline the role of B-mode echography in the diagnosis and follow-up of diaphragmatic anomalies, especially eventration, and suggest that examination of diaphragm and of its motion should complete any abdominal and thoracic echography.