Diagnóstico de hernia diafragmática congénita de presentación tardía mediante ecografía a pie de cama

An 11-month-old boy presented to the pediatric emergency department (PED) of a spoke hospital after a 1-day history of fussiness, inconsolable crying, and two vomits. Upon admission, he appeared alert, yet pale and fussy. Physical examination revealed mild abdominal tenderness and a palpable mass in the left lower quadrant. A few hours later, drowsiness and oral intake refusal appeared. The laboratory test results were normal. A chest X-ray (CXR) revealed a left lower consolidation with possible effusion (Fig. 1,a). Moreover, abdominal ultrasound showed a large gastric shadow and dilated small intestinal loops with hydro-air levels.Upon admission, the patient, who had been promptly referred to our tertiary care PED, was in a good clinical condition and had no pathological findings on pulmonary auscultation. A lung point-of-care ultrasound (LUS) conducted by an emergency pediatrician, using a high frequency (7e15 MHz) linear transducer, with the patient placed in both the supine and sitting positions to scan all the chest walls, revealed a bowel with active peristalsis in the left emithorax as well as partial absence of the part of the affected hemidiaphragm and partial absence of the pleural line; therefore, the most likely diagnosis was congenital diaphragmatic hernia (CDH) (Fig. 1,b).Computed tomography (CT) scan (Fig. 1,c) and explorative laparotomy were performed. The left CDH was confirmed and mainly repaired during surgery. The postoperative period was uneventful and the patient was discharged from the hospital 8 days later.

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A prompt diagnosis of late-onset congenital diaphragmatic hernia with Point of Care Ultrasound (POCUS) in a Pediatric Emergency Department

Delmonaco

Genisio

Scottoni

et al. 2021

Pediatrics & Neonatology

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Diagnóstico de hernia diafragmática congénita de presentación tardía mediante ecografía a pie de cama

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A prompt diagnosis of late-onset congenital diaphragmatic hernia with Point of Care Ultrasound (POCUS) in a Pediatric Emergency Department

A prompt diagnosis of late-onset congenital diaphragmatic hernia with Point of Care Ultrasound (POCUS) in a Pediatric Emergency Department

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