ศาสตราจารย์แพทย์หญิงสุภรี สุวรรณจูฑะ INTERESTING CASE ROUND ศาสตราจารย์แพทย์หญิงสุภรี สุวรรณจูฑะ

ผู้ป่วย 5 เด็กอายุ 1 ปี อาการสำคัญ: ไข้ ไอ หอบ

What is your diagnosis?

Eventration of diaphragm vs diaphragmatic hernia Diagnosis : Eventration of diaphragm vs diaphragmatic hernia

What is your diagnosis and plan of management ? ผู้ป่วย 6 เด็กอายุ 4 เดือน มี persistent pneumonia หลังให้การรักษา What is your diagnosis and plan of management ?

ผู้ป่วย 6 เด็กอายุ 4 เดือน ภายหลังฉีดลมเข้าในท้อง Dx: Diaphragmatic hernia, most likely Morgagni hernia

Diaphragmatic Deformities Congenital Diaphragmatic Hernia of Bochdalek Congenital Anterior Diaphragmatic Hernia (Morgagni Hernia)

Congenital Diaphragmatic Hernia of Bochdalek Posterolateral diaphragmatic hernia through the pleuroperitoneal sinus is perhaps the most urgent of all neonatal thoracoabdominal emergencies. The maldevelopment is left-sided in 85 to 90 % of the cases.

Congenital Diaphragmatic Hernia of Bochdalek Diagnosis in NB: Immediate cardio-respiratory distress, does not clear with pharyngotracheal cleaning. Fairly constant cyanosis, dyspnea, tachypnea, and tachycardia The involved hemithorax is relatively protuberant. Chest expansion is bilaterally uneven.

Congenital Diaphragmatic Hernia of Bochdalek Diagnosis in NB: Breath sounds are absent on the left, and percussion may be resonant. It is unusual to hear thoracic peristalsis. The apical cardiac impulse is dislocated to the right. The abdomen is scaphoid.

Congenital Anterior Diaphragmatic Hernia (Morgagni Hernia) Morgagni hernias occur behind the sternum through defects in the diaphragm that are perhaps secondary to a developmental failure of the retrosternal segment of the septum transversum.

Congenital Anterior Diaphragmatic Hernia (Morgagni Hernia) The defect on the left is usually obliterated by pericardium therefore, most of the hernias are on the right. It many infants and children, anterior diaphragmatic defects are asymptomatic, and the hernia is found incidentally on chest roentgenogram.

Congenital Anterior Diaphragmatic Hernia (Morgagni Hernia) The diagnosis may be ultimately supported by roentgenograms showing a moderately dense tumor, usually at the right cardiophrenic angle in the posteroanterior film and in the anterior mediastinum on the lateral view.