Diaphragmatic Eventration Research Articles

Visual Assessment of CT Findings in Smokers With Nonobstructed Spirometric Abnormalities in The COPDGene® Study.

Within the COPD Genetic Epidemiology (COPDGene®) study population of cigarette smokers, 9% were found to be unclassifiable by the Global Initiative for chronic Obstructive Lung Disease (GOLD) criteria. This study was to identify the differences in computed tomography (CT) findings between this nonobstructed (GOLDU) group and a control group of smokers with normal lung function. This research was approved by the institutional review board of each institution. CT images of 400 participants in the COPDGene® study (200 GOLDU, 200 smokers with normal lung function) were retrospectively evaluated in a blinded fashion. Visual CT assessment included lobar analysis of emphysema (type, extent), presence of paraseptal emphysema, airway wall thickening, expiratory air trapping, centrilobular nodules, atelectasis, non-fibrotic and fibrotic interstitial lung disease (ILD), pleural thickening, diaphragmatic eventration, vertebral body changes and internal thoracic diameters (in mm). Univariate comparisons of groups for each CT parameter and multiple logistic regression were performed to determine the imaging features associated with GOLDU. When compared with the control group, GOLDU participants had a significantly higher prevalence of unilateral diaphragm eventration (30% vs. 16%), airway wall thickening, centrilobular nodules, reticular abnormality, paraseptal emphysema (33% vs. 17%), linear atelectasis (60% vs. 35.6%), kyphosis (12% vs. 4%), and a smaller internal transverse thoracic diameter (255 ± 22.5 [standard deviation] vs. 264.8 ± 22.4, mm) (all p<0.05). With multiple logistic regression, all of these CT parameters, except non-fibrotic ILD and kyphosis, remained significantly associated with GOLDU status (p<0.05). In cigarette smokers, chest wall abnormalities and parenchymal lung disease, which contribute to restrictive physiologic impairment, are associated with GOLD-nonobstructed status.

著明な拘束性障害を来たした横隔膜弛緩症に対する胸腔鏡下横隔膜切除術の1例

著明な拘束性障害を来たした横隔膜弛緩症に対する胸腔鏡下横隔膜切除術の1例

Diaphragmatic Eventration Secondary to Ectopic Kidneys

Diaphragmatic Eventration Secondary to Ectopic Kidneys

Neonatal gastric perforation: A single center experience.

To determine the etiology and prognostic factors for neonatal gastric perforation (NGP), a rare but life-threatening disease. Between 1980 and 2011, nine patients underwent surgical intervention for NGP at Seoul National University Children's Hospital. The characteristics and prognosis of the patients were retrospectively analyzed. Among the nine patients, three (33.3%) were preterm babies and five (55.5%) had associated anomalies, which included diaphragmatic eventration (n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three (33.3%) patients were born before 1990 and three (33.3%) had a birth weight < 2500 g. Pneumoperitoneum was found on preoperative images in six (66.7%) patients, and incidentally in the other three (33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven (77.8%) patients. The overall mortality rate was 22.2% (2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not. Early detection and advances in neonatal intensive care may improve the prognosis of NGP.

Eventration of Diaphragm Presenting As Recurrent Respiratory Tract Infections- A Case Report

Eventration of the diaphragm (ED) is a relatively rare condition. Eventration of the diaphragm is an abnormal elevation of the dome of diaphragm in which all or part of the diaphragm is largely composed of fibrous tissue. Clinical manifestations range from asymptomatic to life threatening respiratory distress. Recurrent chest infections are also the presenting complaints in patients. We report a 7 year old boy who presented with recurrent chest infections with left diaphragm eventration treated by plication successfully.

Classification of chronic obstructive pulmonary disease based on chest radiography

Objective Quantitative analysis of chest radiographs of patients with and without chronic obstructive pulmonary disease (COPD) determining if the data obtained from such radiographic images could classify such individuals according to the presence or absence of disease. Materials and Methods For such a purpose, three groups of chest radiographic images were utilized, namely: group 1, including 25 individuals with COPD; group 2, including 27 individuals without COPD; and group 3 (utilized for the reclassification /validation of the analysis), including 15 individuals with COPD. The COPD classification was based on spirometry. The variables normalized by retrosternal height were the following: pulmonary width (LARGP); levels of right (ALBDIR) and left (ALBESQ) diaphragmatic eventration; costophrenic angle (ANGCF); and right (DISDIR) and left (DISESQ) intercostal distances. Results As the radiographic images of patients with and without COPD were compared, statistically significant differences were observed between the two groups on the variables related to the diaphragm. In the COPD reclassification the following variables presented the highest indices of correct classification: ANGCF (80%), ALBDIR (73.3%), ALBESQ (86.7%). Conclusion The radiographic assessment of the chest demonstrated that the variables related to the diaphragm allow a better differentiation between individuals with and without COPD.

A preliminary report on the feasibility of single-port thoracoscopic surgery for diaphragm plication in the treatment of diaphragm eventration

IntroductionThoracoscopic surgery is a popular widely used surgical technique in the treatment of common chest conditions. Conventional thoracoscopic surgery utilizes multiple small wounds for carrying out the procedure. Many procedures can also be performed with a single small port wound. In this study, we performed diaphragm plication using the techniques of single-port thoracoscopic surgery.Materials and methodsFrom July 1st, 2008 to December 31th, 2011, there were 21 patients admitted to our hospital due to diaphragm eventration. All of them underwent diaphragm plication. The initial 11 patients underwent two-port thoracoscopic surgery while the subsequent 10 patients underwent single-port thoracoscopic surgery.ResultsThe side of diaphragm eventration was on the left in all of the cases. The mean operative time was 87.3 minutes and the mean follow-up time was 17 months. There was no procedure-related complication or mortality. The time required for surgery and the postoperative pain scores were similar in the two groups.ConclusionSingle-port thoracoscopic surgery for diaphragm plication is a safe procedure. It can serve as an alternative to conventional thoracoscopic approaches to diaphragm surgery.

Acute Gastric Volvulus in a Six-Year-Old: A Case Report and Review of the Literature

BackgroundFirst described in the pediatric population in 1899 by Oltmann, pediatric gastric volvulus is a rare disease, but carries a high mortality rate. Due to vague signs and symptoms it can easily be mistaken for gastroenteritis or appendicitis, but unique radiographic findings can help illuminate the diagnosis. The pathophysiology of gastric volvulus is related to an abnormality in the attachment of at least one of the gastric ligaments, which can occur either primarily or secondarily. The abnormality in these ligaments allows the stomach to freely rotate, eventually causing an obstruction. We describe a unique case occurring in a 6-year-old with no pre-exiting medical conditions as well as the associated radiographic images. ObjectivesOur aim is to discuss the presentation and management of a potentially lethal intra-abdominal process that mimics far more benign disease entities and to highlight the pertinent radiographic findings. Case ReportA previously healthy 6-year-old female presented to the emergency department in the middle of the night after sudden onset of vomiting and abdominal pain. On exam her heart rate was mildly elevated but all other vital signs were within normal limits. She was assessed with an abdominal x-ray and given ondansetron. After settling with her parents and having no further bouts of emesis she was sent home. She returned that afternoon febrile with increasing abdominal pain and emesis. Abdominal x-ray revealed a massively distended stomach and left diaphragmatic eventration. She underwent operative intervention and improved over the course of the following week. ConclusionAcute gastric volvulus presents a diagnostic challenge. In patients with vague abdominal complaints knowledge of the typical x-ray findings is essential in early identification and treatment.

Thoracoscopic and laparoscopic plication of the hemidiaphragm is effective in the management of diaphragmatic eventration

Diaphragmatic plication by minimally invasive surgery is thought to allow for a quick recovery and has been performed on small children. Here, we report our experience with different plication procedures to discuss how to choose among these different plication procedures in endoscopic surgery for pediatric patients with diaphragmatic eventration. We retrospectively analyzed clinical data of 27 pediatric patients (21 boys, 6 girls; median age: 12.7 months, range 2 months-3 years) admitted to our hospital between November 2008 and July 2013. Three different plication procedures were used: the "reefing the mainsail" technique (8 patients), "invaginating the diaphragmatic dome" technique (10 patients), and "pleating" technique (9 patients). Indications included ventilator dependency (7.41 %), respiratory distress (22.22 %), chronic lung lobe collapse (11.11 %), persistent atelectasis with recurrent pneumonias (18.52 %), and asymptomatic severe eventration (40.74 %). Descending distance of diaphragm after surgery ranged from 1 to 4.5 intercostal spaces (mean distance: 2.65 intercostal spaces). All patients recovered well postoperatively, except for one patient with a pneumothorax. Two patients who required respiratory support before the operation no longer required it within 7 d after surgery. Follow-up ranged from 1 to 35 months. Clinical results were satisfactory with obvious improvement in symptoms and a slight re-elevation within a distance of one intercostal space. For pediatric patients with diaphragmatic eventration, different endoscopic surgeries and plication procedures all yielded satisfactory results. We believe that the choice of one procedure over the other depends only on the surgeon's experience.

A Simple Technique for Thoracoscopic Treatment of Diaphragmatic Eventration

True diaphragmatic eventration is a rare congenital defect that is most commonly asymptomatic, but can result in dyspnea and recurrent respiratory infections. Advancements in endoscopic technology and technique have resulted in minimally invasive methods for repair of this defect with pronounced benefit when compared to the open thoracotomy. We report a case in which a two year old male who suffered from recurrent respiratory infections was found to have unilateral right diaphragmatic eventration that underwent plication utilizing thoracoscopy and cutting endostaplers with Peri-strips. This procedure was followed by a remarkably fast recovery and discharge, improved radiological findings, and a reprieve from respiratory infection.

Laparoscopic Transperitoneal Repair of Pediatric Diaphragm Eventration Using an Endostapler Device

Minimally invasive repairs of pediatric diaphragm eventration have been well described via a thoracoscopic approach, oftentimes requiring single-lung ventilation and tube thoracostomy, with the disadvantage of not being able to clearly visualize what lies beneath the diaphragm. We describe a novel pediatric diaphragm eventration repair using a laparoscopic transperitoneal approach and an endostapler device. We also describe our initial experience with this technique. Four pediatric diaphragmatic eventration patients underwent laparoscopic transperitoneal repair using an endostapler device. Repairs were performed in both male and female patients with right-sided eventrations. We approach the repair in a transperitoneal fashion using inverting sutures at the apex of the diaphragm to create tension toward the pelvis. Subsequently, an endostapler is used to remove the redundant portion of diaphragm, leaving a repaired, taut diaphragm. The median age at operation was 10.5 months. The median operative time was 70 minutes. There was no mortality, surgical complications, or recurrence at a median follow-up of 17 months. This laparoscopic approach allows for clear visualization of the intraabdominal organs and, at least in our early experience, a very simple, straightforward operation. Additionally, with the use of the endostapler, the redundant, often weakened diaphragm is removed, leaving the native, healthy diaphragm behind, resulting in a reliable and reproducible repair. This repair should be considered as a feasible alternative approach to the more traditional open and thoracoscopic repairs.

Management of a Patient with Unstable Angina, Left Main Coronary Artery Disease, and Respiratory Insufficiency Due to Eventration of the Diaphragm

The incidence of eventration of diaphragm before cardiac surgery is rare. We describe the management of a patient with eventration of the diaphragm who underwent a coronary artery bypass grafting (CABG) for left main coronary artery disease followed by left diaphragm plication with video-assisted thoracic surgery (VATS) for the postoperative respiratory insufficiency.

Thoracoscopic Treatment of Congenital Diaphragmatic Eventration in Children: Lessons Learned After 15 Years of Experience

We present our experience with the thoracoscopic treatment of congenital diaphragmatic eventration (CDE) in children through 15 years to evaluate the efficiency of the procedure and the potential risk of recurrence. Materials and We reviewed the medical files of patients treated for CDE through thoracoscopy from 2000 to 2011. Age at surgery, sex, side of the lesion, procedure's details, postoperative course, and complications were analyzed. Mean follow-up was 12 months. In this study, eight patients (five males and three females) aged from 6 months to 7 years underwent thoracoscopic plication for six right and two left eventrations; one conversion was necessary due to a too small operative field. Mean operative time was 60.5 minutes. A chest drainage was placed in six patients. We observed two recurrences from which the first one was treated thoracoscopically by endostapler resection/suturing and the other one by laparotomy. At follow-up, all patients were asymptomatic with a correct level of the diaphragm. Thoracoscopic plication is feasible and safe, and we consider this approach as the gold standard for the treatment of CDE. However, we still need to carefully consider the possibility of introducing certain modifications to reduce the potential risk of recurrence.

English

Background: Eventration of diaphragm is defined as an abnormal elevation of an intact diaphragm and most often is characterized by a developmental abnormality of the diaphragm musculature. It usually remains asymptomatic in early life and presents later with respiratory and gastrointestinal complications. It is also seen in acquired conditions like phrenic nerve dysfunction in old age. Material and methods: A 64 yr man came with abdominal discomfort and fullness with nonbilous intermittent vomitings for 20days and unable to take food. Chest roentgenogram revealed an elevated left hemidiaphragm and a shift of the lower mediastinum to right. Barium study showed gastric volvulus. CT scan showed eventration of left dome of diaphragm with gastric volvulus. Results: The procedures were performed laparoscopically and follow up showed excellent results. Patient recovered well with symptomatic relief. conclusion: All cases of diaphragmatic eventration do not require surgical intervention if it is not associated with adverse symptoms. However treatment of laparoscopic mesh repair by abdominal approach is indicated if it is symptomatic. Laparoscopic approach has become an attractive alternative because of its association with less postoperative pain and better cosmesis.

Reconstruction of recurrent diaphragmatic eventration with an elongated polytetrafluoroethylene sheet

We report the case of a 31-year old woman with recurrence of left diaphragmatic eventration 3 years after a previous surgery for this condition. At the initial occurrence, she had experienced dyspnoea on exercise and subsequently underwent laparoscopic plication of the diaphragm with an endo-stapler at a local hospital. Immediately after the operation, the diaphragm was torn and the intestine entered the thorax. Therefore, plication involving sewing was performed. Then, 3 years later, the patient again experienced dyspnoea and was diagnosed as having recurrence of left diaphragmatic eventration. Observation under thoracoscopy revealed that the centre of the left diaphragm was thin but not torn. We reconstructed the left diaphragm with an elongated polytetrafluoroethylene sheet on the naïve diaphragm. The patient was discharged from our hospital 5 days after surgery. Her respiratory function improved and she has not experienced recurrence.

Robot-Assisted Thoracoscopic Surgery with Simple Laparoscopy for Diaphragm Eventration

Robot-assisted thoracoscopic surgery has been applied for general thoracic operations. Its advantages include not only those of minimally invasive surgery but also those of magnified three-dimensional vision and angulation of the robotic arm. However, there are no direct tactile sensation and force feedback, which can cause unwanted organ damage. We therefore used laparoscopy simultaneously to avoid a blind intraperitoneal area during robotic surgery for diaphragmatic eventration via transthoracic approach and describe the technique herein.

Eventration of Diaphragm or Pseudo Pleural Effusion

Background : Physicians frequently encounter chest-x ray reports of pleural effusion in patients. Thoracocentesis is the second step to diagnosis, but if there isn’t any effusion actually, thoracocentesis may lead to complication. Case Report: A 47-year-old man with a history of dyspnea and dry cough and posteroanterior (PA) chest x-ray (and right lateral decubitus) report of pleural effusion referred for thoracocentesis, but vesicular sounds at over the lungs were normal. Spiral lung CT scan revealed localized eventration of diaphragm. Conclusion: Localized eventration of right diaphragm may cause the appearance of pleural effusion in PA and also right lateral decubitus chest x-ray.

The evaluation of cases with pneumothorax in the neonatal intensive care unit

Objectives: Early diagnosis and treatment is essential in reducing mortality in newborns with pneumothorax. In this study, newborns with a diagnosis of pneumothorax in neonatal intensive care unit of our hospital were evaluated and aimed to increase the awareness of physicians. Methods: 12 cases with pneumothorax were evaluated retrospectively. The gender, birth weight, gestational age, mode of delivery, the presence of underlying disease, pneumothorax localization, implementation of the surfactant and mechanical ventilation and existence or absence of mortality were recorded. Results: During the study, pneumothorax was detected 12 patients. Male/female ratio was 1.4. Eight of the patients had born with cesarean delivery, the mean birth weight of cases was 2623±912 g and, 66.7% of cases were term babies. Pneumothorax was observed in the first week of life in all patients and it occurred spontaneously in 4 patients. The frequency of bilateral pneumothorax was 41.7%. For the treatment, closed tube drainage was performed in 9 patients. The overall mortality rate was 66.7%. Half of the patients who died had congenital anomalies such as diaphragmatic eventration (n=1), hydrocephalus (n=1), encephalocel (n=1), non-immune hydrops fetalis (n=1). Conclusion: Additional congenital anomalies, such as PDAs and persistent pulmonary hypertension were found to be effective on mortality in neonates with pneumothorax. Although, it is a life-threatening condition, the emergency treatment is life saving. Therefore, in patients with risk factors, keeping pneumothorax in mind is also the first step of the treatment.

Diaphragmatic Plication: Retrospective Study with 54 Patients

Objective: This study seeks to evaluate the results of surgery performed according to the etiological causes of diaphragmatic eventration or paralysis. Method: Files of 54 patients (35 males, 19 females; mean age: 39.1 ± 3.01 years) who had undergone diaphragm plication between January 2005 and June 2011 in two clinics located in Istanbul were studied in terms of pulmonary spirometry, applied surgical procedure, duration of hospitalization, morbidity, and mortality. Results: In diaphragm plications, observed etiologies were isolated diaphragmatic eventration without phrenic nerve injury (Group 1) in 20 (37%) patients due to blunt thoracic trauma; Group 2 (thymoma in 19 (35.2%) patients; lung cancer in 7 (12.9%) patients; mediastinal tumor in 3 (5.6%) patients) and congenital heart surgery (Group 3) in 5 (9.3%) patients. The mean time to plication was 7.4 months in Group 1. The mean duration of hospitalization was 4 days in Group 1, 6.2 days in Group 2, 11.8 days in Group 3. Mean forced vital capacity, forced expiratory volume at 1 second improved by 17%, 20.3%, respectively (p In Group 1, mean dyspnea-related hospital admission before plication was 2.4 times. At the end of 6 months after plication mean dyspnea-related hospital admission was 0 time. All of them returned to daily activities or their job within 6 months in Group 1. Postoperative mortality was observed in 2 (3.7%) patients in Group 3 while the overall complication rates were 24%. The morbidity rates were 8%, 27.5%, 60%, respectively; and the mortality rates were 0%, 0%, 40%, respectively. Conclusion: As a result, it could be suggested that early and timely performed plications for diaphragmatic eventration improves functional status and assesses a shorter lenght of stay. On the other hand,simultaneously performed plications in intraoperative phrenic nerve resections can be performed with acceptable morbidity and no mortality. In diaphragmatic paralysis due to congenital heart surgery, morbidity and mortality rate is still high.

Bilateral eventration of the diaphragm: report of a case and reviw of the literature

Introduction. Diaphragmatic eventration is a congenital malforma- tion which could result in respiratory distress. A chest X-ray, shows an elevated diaphragm. Most case reports present unilateral dia- phragmatic eventration. We report a case of an infant with bilateral diaphragmatic elevation. Case report. A 17 day old infant presented with respiratory distress. With the aid of an Xray study we diagnosed a bilateral congenital eventration of the diaphragm (BCED). A bilateral thoracotomy was performed. Discussion. Congenital diaphragmatic eventration represents 5% of all diaphragmatic pathology. There have been few reports of bilateral congenital diaphragmatic eventration. We found only nine reported cases since 1973, and only one in Mexico and Latin America. A bilateral diaphragmatic placation in our patient was successful.