Imaging clinical case

  • Catarina Ferraz de Liz Pediatrics Department, Centro Hospitalar Tâmega e Sousa
  • Sónia Lira Pediatrics Department, Centro Hospitalar Tâmega e Sousa
  • Sandra Teixeira Pediatrics Department, Centro Hospitalar Tâmega e Sousa
Keywords: cerebral palsy, diaphragmatic hernia, scoliosis

Abstract

3000 children. They are mostly of congenital origin and the left hemithorax is most commonly affected. Acquired diaphragmatic hernias are rare and mainly traumatic or iatrogenic. The case of a 16-year-old adolescent with cerebral palsy submitted to scoliosis surgical correction five months earlier is presented. The girl was brought to the emergency department due to dyspnea and vomiting of acute onset.
At physical examination, she was agitated and presented with skin pallor, polypnea, and suprasternal and subcostal retraction. Pulmonary breath sounds in the left hemithorax were absent. The girl maintained blood oxygen saturation levels of 90% with 2 L/ min of O2 and was hemodynamically stable.
The x-ray showed the gastric bubble in the left hemithorax, leading to the diagnosis.
This case shows the clinical challenge posed by children with children with cerebral palsy, who are unable to define their symptoms and make clinical state difficult to access.
Repair of neuromuscular scoliosis has higher complication rates than congenital or idiopathic scoliosis. Diaphragmatic hernia is an uncommon complication, with only few cases described in the literature.

References

1. El-Gohary Y, Schuster I, Scriven R, Coren C, Kessler E, Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked, J Ped Surg Case Reports. 2014; 2:515-8.

2. Bettolli M, Jackson CC, Sweeney B, Rubin S. Iatrogenic anterior diaphragmatic hernia in childhood. Eur J Pediatr Surg. 2008; 18:275-6.

3. Hicks JM, Singla A, Shen FH, Arlet V: Complications of pedicle screw fixation in scoliosis surgery. A systematic review. Spine. 2010; 35:E465–70.
Published
2019-07-18
Section
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