Ayşegül DOĞAN, Selçuk UZUNER, Gönül AYDOĞAN, Filiz ASLAN, Meliha ARSLAN, Gülay A. TİREL, Suat BİÇER

Pnömotoraks olarak yanlış tanı alan bir konjenital diyafragma hernisi olgusu

Acil çocuk servisine taşipne ve solunum sıkıntısı bulgularıyla getirilen 28 günlük bir yenidoğanın akciğer grafisinde sol akciğerde pnömotoraks düşündüren serbest hava görünümü mevcuttu. Bu bulgu üzerine toraks tüpü uygulanması düşünülen hastaya, olası diğer tanıları ayırt etmek için yapılan toraks ultrasonografisinde, akciğer grafisinde pnömotoraks olmayıp diyafragma hernisi olduğu görüldü; gastrointestinal sistem pasaj grafisiyle konjenital diyafragma hernisi tanısı kesinleştirildi. Herni redüksiyonu ve cerrahi tamir yapıldı ve hasta taburcu edildi. Geç ortaya çıkan konjenital diyafragma hernisi düşünüldüğünde ultrasonografi uygun bir tanı aracıdır. Bu olgu, ilk düşünülen tanının pnömotoraks olması nedeniyle, konjenital diyafragma hernisi ayırıcı tanısına dikkat çekilmek için sunulmuştur.

A case of congenital dıaphragmatic hernia misdiagnosed as pneumothorax

A 28 day- old girl who had tashipnea and difficulty in breathing was referred to the Children Emergency Unit in our hospital. In the postero-anterior X-ray of the chest, appearance of free air led to the possible diagnosis of pneumothorax. Based on X-ray appearance, a chest tube was planned to be placed; before this procedure, ultrasound of the chest was performed to distinguish other possible diagnoses. Chest ultrasonography revealed diaphragmatic hernia. Congenital diaphragmatic hernia (CDH) was confirmed using barium study. Hernia reduction and surgical repairment were performed and the patient was discharged. Although pneumothorax was our initial diagnosis, after the procedures that were performed, the true diagnosis of congenital diaphragmatic hernia was established. Chest ultrasonography seems as a good diagnostic tool when lately presented congenital diaphragmatic hernia is suspected. This case of congenital diaphragmatic hernia misdiagnosed as pneumothorax was presented here in order to attract attention to pneumothorax as a differential diagnosis in patients with CDH

PDF

___

1) Berman L, Stringer D, Ein SH, Shandling B. The late presenting pediatric Bochdalek hernia: a 20 year review. J Pediatr Surg 1988; 23: 735-739.
2) Booker PD, Meerstadt PW, Bush GH. Congenital diaphragmatic hernia in the older child. Arch Dis Child 1981; 56: 253-257.
3) Coren ME, Rosenthal M, Bush A. Congenital diaphragmatic hernia misdiagnosed as tension pneumothorax. Pediatr Pulmonol 1997; 24: 119-121.
4) Fein JA, Loiselle J, Eberlein S, Wiley JF, Bell LM. Diaphragmatic hernia masquerading as pneumothorax in two toddlers. Ann Emerg Med 1993; 22: 1221-1224.
5) Gary EH. Diaphragmatic Hernia. In: Richard EB, Robert MK, Hal B (eds). Nelson Textbook of Pediatrics (17th ed), WB Saunders Co, Philadelphia 2004, pp.1353-1355.
6) Gleeson F, Spitz L. Pitfalls in the diagnosis of congenital diaphragmatic hernia. Arch Dis Child 1991; 66: 670 -671.
7) Greer JJ, Babiuk RP, Thebaud B. Etiology of congenital diaphragmatic hernia: the retinoid hypothesis. Pediatr Res 2003; 53: 726-730.
8) Oh KS, Newman B, Bender TM, Bowen A. Radiological evaluation of the diaphragm. Radiol Clin North Am 1988; 26: 355- 364.
9) Snyder HS, Salo DF, Kelly PH. Congenital diaphragmatic hernia presenting as massive gastrothorax. Ann Emerg Med 1990;19: 562-564.
10) William ET. Pulmonary Hypoplasia and Congenital Diaphragmatic Hernia. In: Colin DR, Abraham MR (eds). Rudolph's Pediatrics (21st ed), McGraw-Hill Co. USA 2002, pp.189-190.