Imaging case

  • Sandra Vanessa Dias Pereira Department of Pediatrics, Centro Hospitalar de São João
  • Maria Adriana Rangel Department of Pediatrics, Centro Hospitalar Vila Nova de Gaia/Espinho
  • Alexandra Martins Department of Pediatrics, Centro Hospitalar Entre o Douro e Vouga
  • Marta Sousa Department of Radiology and Medical Imaging, Centro Hospitalar Entre o Douro e Vouga
  • Cristina Rocha Department of Pediatrics, Centro Hospitalar Entre o Douro e Vouga
  • Arménia Oliveira Department of Pediatrics, Centro Hospitalar Entre o Douro e Vouga
Keywords: Congenital diaphragmatic hernia, cough, failure to thrive, pediatrics

Abstract

Introduction: Congenital Bochdalek Diaphragmatic Hernia (CBDH) is a relatively rare entity and may be underdiagnosed due to not being correctly recognized after the neonatal period.
Case report: An eight-month-old Caucasian infant with failure to thrive, presented to the emergency service with productive cough since the previous week. He was amoxicillin/ clavulanic acid prescribed seven days before for an acute otitis media and was afebrile for the past four days. Past history revealed failure to thrive and feeding difficulties. Chest radiograph was misleading, with multiple differential diagnosis, namely eventration and necrotizing pneumonia. Abdominal ultrasonography and thoracoabdominal magnetic resonance imaging revealed CBDH with non-obstructive gastric volvulus.
Discussion: Pediatricians should include late-onset CBDH as a differential diagnosis in any child with recurrent non-specific respiratory or gastrointestinal tract symptoms. Early surgical correction of diaphragmatic defect is crucial to prevent the possible risk of strangulation and severe respiratory problems.

References

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Published
2018-07-13
Section
What is your Diagnosis?