Ultrasound Diagnosis of a Strangulated Diaphragmatic Hernia in a Child. Сlinical Observation

Abstract

Diaphragmatic hernia occurs in newborns in the vast majority of cases and is diagnosed while still in utero. Cases of it delayed diagnosis are extremely rare and involve significant diagnostic difficulties, especially when there are ischemic damages to the organs that make up the hernial contents. The clinical manifestations of a strangulated diaphragmatic hernia are nonspecific, especially in young children, when adequate verbal contact is impossible.Objective. We demonstrate the possibilities and limitations of various radial methods of examination of a child with a strangulated diaphragmatic hernia.Materials and Methods. We present an observation of an 8-month-old child with a leftsided strangulated false diaphragmatic hernia. The child was subjected to ultrasound, radiologic examination (image in supine position in direct posterior projection), CT scan (native scan without breath-holding). Radiologic findings were compared with the intraoperative picture. Results. The history of the disease was unclear, the clinical picture was nonspecific, respiratory failure prevailed. Radiologic diagnosis was difficult because of the combined disease: pneumonia, left-sided pleuritis. The diagnosis was made at ultrasound when hollow organ fragments were visualized in the left hemithorax and confirmed by CT scanning. The child was successfully operated.Conclusion. Congenital diaphragmatic hernia in rare cases may exist asymptomatic for a long period of time and present with extremely nonspecific clinical manifestations. It is necessary to remember the possibility of the presence of previously undiagnosed diseases and developmental anomalies when performing chest ultrasound in children, because they fundamentally affect the management of the patient.