Partial presentation is frequent in the anteromedial region of the right hemidiaphragm, whereas complete presentation is commonly found in the left hemidiaphragm [ 12 ]. Diaphragm plication in adult patients with diaphragm paralysis leads to long-term improvement of pulmonary function and level of dyspnea. National Center for Biotechnology Information , U. Axial view of the Chest CT-scan IV and oral contrast showing gastric and bowel contents in the left hemithorax. Abstract Presented case was a year-old deceased man with a sequel of poliomyelitis who was reportedly found death at home.
Mesh placement on the hemidiaphragm fixed in the anterolateral position. In this patient, she presented with symptoms similar to diaphragmatic hernia, thus a combination of imaging modalities help in the diagnosis in this patient. However, it has been argued that these methods lacked discriminative power as for diaphragm paralysis, and fluoroscopic evaluations were reported as more helpful in the revealment of anatomical, and functional status of the diaphragm 7. Author information Copyright and License information Disclaimer. Its unbroken continuity differentiates it from diaphragmatic hernia . Baquir MD — data analysis and interpretation. In infants, the symptoms are severe due to the poor development of the thoracic cage and weakness of the intercostal muscles that cause paradoxical breathing and require the use of mechanical ventilation [ 3 , 13 ].
No manipulation or treatment is necessary for asymptomatic thoracic kidneys, except when there are other pathologies vesicoureteral reflux or obstruction [ 32 ], such as those found in this patient.
Case Reports in Surgery
Diaphragmatic eventration 2,3,5 is frequently reported as a diagnosis of the pediatric age group, however adult male cases like ours are rarely reported in the literature 4,6. The chest radiograph showed expansion of the hemidiaphragm, pulmonary field, and residual renal silhouette in the intrathoracic position Figure View at Google Scholar S. Author information Article notes Copyright and License information Disclaimer.
The prosthetic mesh is used in cases of extreme amyotrophy [ 4 ] by placing it on the surface of the muscle, fixing it in the peripheral diaphragmatic inserts, and preventing recurrence at the ends of the plication; some authors are reluctant to use it due to the possibility of infection and increased cost of surgery, although these criteria are relative, if properly managed.
Ethical approval This paper did not require an ethical approval since it is retrospective case report in nature. In this patient, she presented with symptoms similar to diaphragmatic hernia, thus a combination of imaging modalities help in the diagnosis in this patient.
Congenital unilateral diaphragmatic eventration in an adult: A rare case presentation
It is also believed that alterations in the development of adrenal glands and the liver can vary the position of the kidney [ 910 ]. Computed tomography showed the intestine, mesentery, colon, and kidney inside the right hemithorax Figures 1 — 6 ; uniform and continuous diaphragmatic elevation throughout the hemithorax Figures 5 and 6 ; discrete mediastinal displacement caused by the right kidney Figure 3 ; and hepatic displacement towards the left hemiabdomen causing gastric compression Figure 4.
Eur J Pediatr Surg. Diaphragmatic eventration associated with thoracic renal ectopia is a very rare entity, considering the age, sex, and right location of the condition. Simple cases of diaphragmatic eventration may not require intervention when not associated with adverse symptoms.
Chest Xray taken 1 week post-operatively showing left lung expansion and elevated left hemidiaphragm.
This article has been cited by other articles in PMC. In the present case, the laparoscopic approach was used for diagnosing eventration and not diaphragmatic hernia; it also helped in the partial reduction of intestinal loops and release of adhesions of the colon in the roof of the hemidiaphragm.
But we still recommend surgical therapy as soon as diagnosis is confirmed. The latter is also an acquired condition due to phrenic nerve injury cqse or paresis. Introduction There are four types of congenital diaphragmatic defects: Deeper sole arch angle, and flexed toes, more prominent flexion of the thumb, atrophic and relatively thinner extremities below the knees were observed.
The stretching of the stomach was probably the cause of the epigastric discomfort in this patient. Axial section with the kidney in a posterior position and mild mediastinal compression. Eventrztion revealed visceral displacement, severe elevation of the diaphragmatic dome, and hepatic displacement; there was no diaphragmatic rupture, defined as eventration.
Conflict of interest I have no conflict of interest, this paper was not funded and all of the contents and expenses in the making of this paper is purely voluntary tsudy nature. CASE REPORT As reported by his family, our old male patient who was found dead at home, had suffered from poliomyelitis when he was a child, and also treated for respiratory tract diseases.
It is useful in situations such as pregnancy as it is associated with less morbidity [ 5 ]. This paper did not require an ethical approval since it is retrospective case report in nature. These reports also confirm the normal functionality of the kidney and suggest that in the absence of diaphragmatic defects, surgery would be unnecessary.
An incision was made for hemidiaphragm plication. Guzman MD — concept, collection, data analysis, writing of the paper.
Diaphragmatic Eventration: Autopsy Case Report
This is achieved with diaphragmatic plication and can be performed via thoracotomy or using a minimally invasive laparoscopic or thoracoscopic route, with or without the interposition of a prosthetic material [ 4 — 6 ]. Laparoscopic plication is carried out from the posterior to the anterior position and then from the medial to the eventratiion, of which a detailed description is made by Groth and Andrade [ 317 ].
Microscopically, there is paucity or absence of muscular fibers and diffuse fibro elastic changes. Although the patient had follow-up up until 2 years, long term benefits in these patients are yet still to be determined.
View at Google Scholar. Introduction Diaphragmatic eventration is largely diagnosed in the pediatric age group. The cases reported previously have been associated with congenital diaphragmatic hernia but have not been associated with diaphragmatic eventration, as seen in our case.