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LETTER TO THE EDITOR Table of Contents   
Year : 2011  |  Volume : 8  |  Issue : 2  |  Page : 259-260
Bilateral congenital diaphragmatic eventration: An unusual cause of respiratory distress in an infant


1 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
2 Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India
3 Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh, India

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Date of Web Publication14-Oct-2011
 

How to cite this article:
Sodhi KS, Narsimhan K L, Bhattacharya A, Khandelwal N. Bilateral congenital diaphragmatic eventration: An unusual cause of respiratory distress in an infant. Afr J Paediatr Surg 2011;8:259-60

How to cite this URL:
Sodhi KS, Narsimhan K L, Bhattacharya A, Khandelwal N. Bilateral congenital diaphragmatic eventration: An unusual cause of respiratory distress in an infant. Afr J Paediatr Surg [serial online] 2011 [cited 2014 Nov 1];8:259-60. Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/2/259/86082
Sir,

Eventration of the diaphragm is a condition characterised by an abnormal elevation of an attenuated, but otherwise intact diaphragm. [1],[2],[3] Both congenital and acquired eventrations are usually unilateral. Bilateral eventrations are extremely rare. Unlike unilateral eventrations, bilateral eventrations are almost always associated with significant respiratory compromise in the neonatal period.

A 10-month-old male child presented to our paediatric emergency with complaints of rapid breathing since birth. Examination revealed a conscious, oriented and tachypnoeic child with markedly raised respiratory rate. There was equal air entry on both the sides.

His echocardiography was normal, but the chest X-ray [Figure 1] showed two rounded, well-defined bilateral homogenous paracardiac opacities situated in bilateral cardio-phrenic angles. Radiological possibilities considered were bilateral diaphragmatic eventration/hernias, pleuro-pericardial cysts, congenital cysts, and loculated fluid collections. Contrast-enhanced computed tomography (CT) chest [Figure 2]a and b revealed focal projection of both lobes of liver into thoracic cavities and were seen to occupy the bilateral anterior cardio-phrenic recesses. No evidence of any intrathoracic herniation of stomach, spleen, bowel or any other intra-abdominal contents was seen. Hence, a CT diagnosis of bilateral congenital diaphragmatic eventration was made. Tc 99 m sulphur colloid liver-spleen scan [Figure 3] with multiple static images of the liver following intravenous injection of 1 mCi of Tc 99 m sulphur colloid revealed a normal-sized liver with adequate tracer concentration and a uniform tracer distribution in both the lobes. Separate rounded portions of functional liver tissue were seen to project superiorly into the chest, more so into the right side, suggestive of focal eventrations.
Figure 1: Chest X-ray shows bilateral rounded paracardiac masses

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Figure 2: (a) Axial CT scan images reveals focal projection of both lobes of liver (arrows), into the thoracic cavities and are seen to occupy the bilateral anterior cardio-phrenic recesses, (b) Coronal reformatted CT scan images reveals focal projection of both lobes of liver (arrows), into the thoracic cavities and are seen to occupy the bilateral anterior cardiophrenic recesses

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Figure 3: Tc99m sulphur colloid liver-spleen scan confi rms the CT findings of focal eventrations (arrows point to site of focal liver herniations)

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The findings were confirmed at surgery as bilateral defects in anterior muscular portions of the diaphragm. There was, however, no herniation of stomach, spleen or bowel into the thoracic cavity. Surgical plication of the diaphragm was done successfully. The child had a normal and uneventful postoperative stay.

With a few exceptions, bilateral eventration of the diaphragm has been a uniformly fatal disorder in spite of the surgical intervention in some of these patients. In most cases, death is caused by pulmonary insufficiency, secondary to either pulmonary hypoplasia or recurrent infections. Early simultaneous bilateral repair of the diaphragm is the only definitive treatment for this condition. Hence, early surgical intervention is recommended in all symptomatic cases. [2],[4]

 
   References Top

1.Shah-Mirany J, Schimtz GL, Watson RR. Eventration of the diaphragm: Physiologic and surgical significance. Arch Surg 1968;96:844-50.  Back to cited text no. 1
    
2.Rodgers BM, Hawks P. Bilateral congenital eventration of the diaphragms: Successful surgical management. J Pediatr Surg 1986;21:858-64.  Back to cited text no. 2
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3.Oh A, Gulati G, Sherman ML, Golub R, Kutin N. Bilateral eventration of the diaphragm with perforated gastric volvulus in an adolescent. J Pediatr Surg 2000;35:1824-6.  Back to cited text no. 3
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4.Rao R, Ray R, Sarkar S. Bilateral congenital eventration of the diaphragm. Indian Pediatr 1993;30:1462-5.  Back to cited text no. 4
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Correspondence Address:
Kushaljit Singh Sodhi
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012
India
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DOI: 10.4103/0189-6725.86082

PMID: 22005383

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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