Preoperative Diagnostic Dilemma of Diaphragmatic Eventration

Abstract

Background: Diaphragmatic eventration is an abnormal elevation of the dome of the diaphragm into the thoracic cavity. Neonatal respiratory distress is the most common clinical presentation of diaphragmatic eventration. Direct abdominal organ compression on the lung or lung hypoplasia is the cause of this symptom. Preoperative radiological imaging is important to diagnose diaphragmatic eventration. Chest radiographs, ultrasound, CT scans and MRI can be used to evaluate the anatomy of the diaphragm. In complicated condition, video-assisted thoracoscopy (VATS) play a role as a diagnostic and therapeutic tool to diagnose and manage diaphragmatic eventration. Case presentation: We presented a case of a full-term unfortunate baby delivered via emergency lower segment caesarean section due to bleeding of the placenta previa type III. Immediately post-delivery, the patient had respiratory distress with an episode of desaturation. CT scan showed a focal right hemi-diaphragmatic bulge with liver tissue within. Video-assisted thoracoscopy (VATS) was performed and the diagnosis of right diaphragmatic eventration had been established. Diaphragmatic plication was done via a VATS-assisted thoracotomy approach. Conclusion: Video-assisted thoracoscopy (VATS) plays a role as a diagnostic tool and even as a therapeutic tool to diagnose and manage diaphragmatic eventration. The capability of VATS to provide direct visualization intrathoracically has a great advantage in managing a such case.