Sonographic appearance of a late-diagnosed left bochdalek hernia in a middle-aged woman: Case report and review of the literature

Megremis, Stylianos; Segkos, Nikolaos; Gavridakis, G; Mattheakis, Michael G.; Kehayas, Elias G.; Triantafyllou, Lambros B.; Sfakianaki, Evaggelia; Chalkiadakis, George

doi:10.1002/jcu.20158

Cited by 12 publications

(8 citation statements)

References 27 publications

(33 reference statements)

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“…[ 4 ] This is of particular importance if one were to consider thoracoscopic approach for repair. [ 72 ] The presence of malrotation or volvulus would warrant an abdominal approach. [ 4 7 68 73 ] Several other investigations may play a role in preoperative preparation of these patients, particularly in those with respiratory symptoms.…”

Section: Investigationsmentioning

confidence: 99%

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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Bochdalek hernia (BH) is an uncommon form of diaphragmatic hernia. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. This review summarizes the relevant aspects of its presentation and management, based on the present evidence in the literature. A literature search was performed on PubMed, Google Scholar, and EMBASE for articles in English on BH in adults. All case reports and series from the period after 1955 till January 2015 were included. A total of 180 articles comprising 368 cases were studied. The mean age of these patients was 51 years (range 15-90 years) with a male preponderance of 57% (211/368). Significantly, 6.5% of patients were above 70 years, with 3.5% of these being above 80 years. The majority of the hernias were on the left side (63%), with right-sided hernias and bilateral occurring in 27% and 10%, respectively. Precipitating factors were noted in 24%, with 5.3% of them being pregnant. Congenital anomalies were seen in 11%. The presenting symptoms included abdominal (62%), respiratory (40%), obstructive (vomiting/abdominal distension; 36%), strangulation (26%); 14% of them were asymptomatic (detected incidentally). In the 184 patients who underwent surgical intervention, the surgical approach involved laparotomy in 74 (40.27%), thoracotomy in 50 (27.7%), combined thoracoabdominal approach in 27 (14.6%), laparoscopy in 23 (12.5%), and thoracoscopic repair in 9 (4.89%). An overall recurrence rate of 1.6% was noted. Among these patients who underwent laparoscopic repair, 82% underwent elective procedure; 66% underwent primary repair, with 61% requiring interposition of mesh or reenforcement with or without primary repair. The overall mortality was 2.7%. Therefore, BH should form one of the differential diagnoses in patients who present with simultaneous abdominal and chest symptoms. Minimal access surgery offers a good alternative with short hospital stay and is associated with minimum morbidity and mortality.

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Section: Investigationsmentioning

confidence: 99%

Laparoscopic repair of bochdalek diaphragmatic hernia in adults

Machado

2016

North Am J Med Sci

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“…The sonographic appearance of CDH in adults has been rarely described because it is uncommon. 11,12 In one of the described cases, the herniating content was only intra-abdominal fat, producing a nonspecific finding of ring-down artifacts, 12 whereas in the other case, a disfigured spleen provided a clue to the existence of a diaphragmatic defect. 11 In the index case, we were able to see bowel loops in the left hemithorax and clearly demonstrate the diaphragmatic defect and the altered anatomy of the spleen and kidney using POCUS.…”

Section: Discussionmentioning

confidence: 88%

A 19-Year-Old Young Man With Breathlessness and Opacity in the Left Hemithorax

Muthu

Sagar

Sehgal

et al. 2019

Chest

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A 19-year-old young man presented with exertional breathlessness of 4 years' duration which was nonprogressive. There were no complaints of chest pain, cough, palpitation, hemoptysis, fever, anorexia, or weight loss. He denied history of any addictions. There was no history of trauma to the chest. He had been empirically treated for TB in the past, based on chest radiography finding of left-sided pleural effusion. However, a diagnostic thoracentesis was never attempted. On examination, heart rate and respiratory rate were 82 beats/min and 18 breaths/ min, respectively. The movements of chest were reduced and an impaired note on percussion was noted over the infra-axillary, infrascapular, and mammary areas on the left side. On auscultation, the intensity of breath sounds was reduced over the aforementioned areas. The rest of the physical examination was unremarkable. Chest radiograph revealed obliteration of the left costophrenic angle with a homogenous radiodensity suggestive of a pleural effusion (Fig 1). We performed a point-of-care ultrasonography (POCUS) (Videos 1-3). Question: What does the ultrasound show and what is the most likely diagnosis?Figure 1 -Chest radiograph showing obliteration of the left costophrenic angle with a homogenous radiodensity.

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“…A left‐sided hernia may contain spleen, pancreas, kidney, part of the gastrointestinal tract, and fat. The sonographic (US) findings in the case of a Bochdalek hernia have rarely been reported and, to the best of our knowledge, only one case has been described 3. We describe the US findings in a case of a Bochdalek hernia which contained fat and was only identified through the ring‐down artifact distal to the herniated intra‐abdominal fat.…”

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confidence: 76%

“…US findings of Bochdalek hernia may vary depending on the herniated structures. It may be diagnosed by detection of a discontinuity in the echogenic line of the hemidiaphragm and the presence of bowel in the thorax 3…”

Section: Discussionmentioning

confidence: 99%