Dirk Schaper, P. Göbel (Kinderchirurgie St. Barbara-Krankenhaus Halle/S.), S. Barth (Krankenhaus Paul-Gerhardt-Stift Lutherstadt Wittenberg)  

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3 Months  

Female  

Abdomen-Other and unknown  

congenital  

At the age of 3.5 months, there was a short disturbance in breathing while lying on the stomach (tachypnea). Otherwise, the child was completely healthy. Presentation to pediatrician, X-rays were performed on the 1st and 2nd day of admission in the pediatric department. This was delayed due to a pertussis infection.  

N/A  

<- view X-Ray 1

X-Ray 1: Thorax ap, Half-spherical opacity over the left diaphragm medially. Lung is unremarkable.





<- view X-Ray 2

X-Ray 2: Thorax lateral, Curved area in the hind diaphragmal area.





<- view MRI 1

MRI 1: T1-weighted, coronal: Obvious curving of a parenchymal organ in the thorax.





<- view MRI 2

MRI 2: T1-weighted, coronal: Anatomic identification of the curved structure as the spleen.





<- view MRI 3

MRI 3: T1-weighted, saggital: Curving in the hind diaphragmal area.





<- view OP-Situs 1

OP-Situs 1: laparoscopic intraoperative situation, Spleen is located in a pocket.



<- view OP-Situs 2

OP-Situs 2: laparoscopic intraoperative situation, after luxation of the spleen.


 

Surgery / Histo  

Relaxatio diaphragmatis  

After further diagnostic imaging, the diagnosis of a Bochdalek's hernia was suspected.
For further evaluation of a surgical indication, a diagnostic laparoscopy was performed. There, one could see that the spleen was laying in a hind, medial pocket. After luxation of the spleen, the diagphragmal hernia could be inspected and pleuroperitoneal closure to the thorax could be documented. Because of the small size of the findings and the missing connection to the thorax, as well as the missing reproduceability of the clinical symptoms, there was no further surgical treatments performed.  

N/A  

N/A  

1. Medline:
Mei-Zahav M, Solomon M, Trachsel D, 3. Medline:
Langer JC.br />Bochdalek diaphragmatic hernia: not only a neonatal disease
Arch Dis Child. 2003 Jun; 88(6): 532-5

2. Medline:
Drahovsky P, Dankovcik J, Bodnarova A, Drahovska I, Sabovcik R.
Congenital diaphragmatic hernia manifesting after the neonatal period
Rozhl Chir. 1999 Mar; 78(3): 123-6

3. Medline:
Langer JC.
Congenital diaphragmatic hernia
Chest Surg Clin N Am. 1998 May; 8(2): 295-314  

Diaphragmatic hernia, Diaphragmal hernia, Bochdalek, Bochdalek's Hernia, pleuroperitoneal covering, Diaphragm hernia, child, childhood, pediatric radiology  

Dirk Schaper,P. Bochdalek's Hernia with pleuroperitoneal covering. PedRad [serial online] vol 4, no. 1.
URL: www.PedRad.info/?search=20040127114642