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1.
BMJ Case Rep ; 12(6)2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31229982

RESUMO

Diaphragmatic eventration is a rare entity in the adult population, and usually asymptomatic 1 ; our case is a young man with severe right-sided diaphragmatic eventration with huge dilated colon that has compromised the right hemithorax and caused complete lung collapse and mediastinal shift similar to tension pneumothorax picture with haemodynamic alteration. A single similar case report had been published but did not shed the light on the accurate description of the pathophysiological mechanism of the disease. We believe that such a high abdominal pressure that has transmitted to the thoracic cavity due to the pliable diaphragm causing such a derangment in both the anatomy and the physiology deserves reporting and we think that the term 'thoracoabdominal compartment syndrome' describes it accurately, so we discuss some learning points from our case and things that could have been done better.


Assuntos
Eventração Diafragmática/diagnóstico por imagem , Dispneia/etiologia , Pentalogia de Cantrell/diagnóstico , Pneumotórax/etiologia , Síndromes Compartimentais/diagnóstico , Diagnóstico Diferencial , Eventração Diafragmática/cirurgia , Evolução Fatal , Humanos , Laparotomia/métodos , Masculino , Adulto Jovem
2.
Pulmonology ; 25(4): 223-235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30509855

RESUMO

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.


Assuntos
Diafragma/fisiopatologia , Nervo Frênico/fisiopatologia , Paralisia Respiratória/terapia , Ultrassonografia/métodos , Diafragma/diagnóstico por imagem , Diafragma/inervação , Diafragma/cirurgia , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Fluoroscopia/métodos , Humanos , Microcirurgia/métodos , Nervo Frênico/lesões , Nervo Frênico/patologia , Nervo Frênico/cirurgia , Radiografia/métodos , Respiração Artificial/métodos , Respiração Artificial/tendências , Testes de Função Respiratória/métodos , Paralisia Respiratória/etiologia , Estimulação Elétrica Nervosa Transcutânea/métodos
4.
Can J Cardiol ; 34(12): 1688.e21-1688.e23, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527167

RESUMO

Diaphragmatic eventration in old age is a rare phenomenon. Typically, it is thought to originate as a result of failure of development of the muscles of the diaphragm. Less commonly, it can occur secondary to acquired conditions resulting from spinal cord or phrenic nerve injury and is only detected incidentally when the patient presents with dyspnea, chest infection, or cardiac compression symptoms. Herein, we report a case of right diaphragmatic paralysis in a 58-year-old man with a presentation of marked elevation of the right hemidiaphragm and ascites causing a picture compatible with cardiac tamponade.


Assuntos
Tamponamento Cardíaco/etiologia , Eventração Diafragmática/complicações , Paralisia Respiratória/complicações , Ascite/diagnóstico por imagem , Tamponamento Cardíaco/diagnóstico por imagem , Eventração Diafragmática/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
BMJ Case Rep ; 20182018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30317202

RESUMO

Eventration of diaphragm is an uncommon disorder in which diaphragmatic muscle is replaced by fibroelastic tissue, either partially or completely. Bilateral eventration is even rarer. We present a case of bilateral eventration of diaphragm in newborn with a fibroelastic sac on left side and diaphragmatic eventration with good muscular lips on right side. The right-sided diaphragmatic eventration was not evident initially, but manifested after surgical repair of the left-sided eventration.


Assuntos
Eventração Diafragmática/diagnóstico , Diagnóstico Diferencial , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/cirurgia , Humanos , Recém-Nascido , Masculino
7.
J Neonatal Perinatal Med ; 11(1): 97-99, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689736

RESUMO

We report an unusual presentation of annular pancreas with pneumoperitoneum in a newborn with an associated left sided Erb's palsy. The neurological deficit caused considerable confusion in the diagnosis and unexpected complications after surgery. We highlight the importance of clinical examination and the complications that an Erb's palsy can cause. This unusual triad of Erb's palsy, eventration of diaphragm and annular pancreas has hitherto not been described in literature.


Assuntos
Neuropatias do Plexo Braquial/complicações , Eventração Diafragmática/etiologia , Duodenopatias/etiologia , Obstrução Intestinal/etiologia , Pâncreas/anormalidades , Pancreatopatias/complicações , Anormalidades Múltiplas/diagnóstico , Neuropatias do Plexo Braquial/diagnóstico , Diagnóstico Tardio , Erros de Diagnóstico , Eventração Diafragmática/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Pneumoperitônio/etiologia
8.
Korean J Radiol ; 19(1): 111-118, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29354007

RESUMO

Objective: To evaluate the technical feasibility of four-dimensional (4D) CT for the functional evaluation of the pediatric diaphragm. Materials and Methods: In 22 consecutive children (median age 3.5 months, age range 3 days-3 years), 4D CT was performed to assess diaphragm motion. Diaphragm abnormalities were qualitatively evaluated and diaphragm motion was quantitatively measured on 4D CT. Lung density changes between peak inspiration and expiration were measured in the basal lung parenchyma. The diaphragm motions and lung density changes measured on 4D CT were compared between various diaphragm conditions. In 11 of the 22 children, chest sonography was available for comparison. Results: Four-dimensional CT demonstrated normal diaphragm (n = 8), paralysis (n = 10), eventration (n = 3), and diffusely decreased motion (n = 1). Chest sonography demonstrated normal diaphragm (n = 2), paralysis (n = 6), eventration (n = 2), and right pleural effusion (n = 1). The sonographic findings were concordant with the 4D CT findings in 90.9% (10/11) of the patients. In diaphragm paralysis, the affected diaphragm motion was significantly decreased compared with the contralateral normal diaphragm motion (-1.1 ± 2.2 mm vs. 7.6 ± 3.8 mm, p = 0.005). The normal diaphragms showed significantly greater motion than the paralyzed diaphragms (4.5 ± 2.1 mm vs. -1.1 ± 2.2 mm, p < 0.0001), while the normal diaphragm motion was significantly smaller than the motion of the contralateral normal diaphragm in paralysis (4.5 ± 2.1 mm vs. 7.6 ± 3.8 mm, p = 0.01). Basal lung density change of the affected side was significantly smaller than that of the contralateral side in diaphragm paralysis (89 ± 73 Hounsfield units [HU] vs. 180 ± 71 HU, p = 0.03), while no significant differences were found between the normal diaphragms and the paralyzed diaphragms (136 ± 66 HU vs. 89 ± 73 HU, p = 0.1) or between the normal diaphragms and the contralateral normal diaphragms in paralysis (136 ± 66 HU vs. 180 ± 71 HU, p = 0.1). Conclusion: The functional evaluation of the pediatric diaphragm is feasible with 4D CT in select children.


Assuntos
Diafragma/diagnóstico por imagem , Tomografia Computadorizada Quadridimensional , Paralisia Respiratória/diagnóstico , Eventração Diafragmática/diagnóstico , Eventração Diafragmática/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Paralisia Respiratória/diagnóstico por imagem , Estudos Retrospectivos , Ultrassonografia
9.
Ann R Coll Surg Engl ; 99(7): e196-e199, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28853592

RESUMO

Diaphragmatic eventration is an uncommon condition, usually discovered incidentally in asymptomatic patients. Even in symptomatic patients, the diagnosis can be challenging and should be considered among the differential diagnoses of diaphragmatic hernia. The correct diagnosis can often only be made in surgery. We describe the case of a 31-year-old patient with diaphragmatic eventration that was misdiagnosed as a recurrent congenital diaphragmatic hernia and review the corresponding literature.


Assuntos
Eventração Diafragmática/diagnóstico , Hérnia Diafragmática/diagnóstico , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/cirurgia , Hérnia Diafragmática/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/diagnóstico , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Masculino , Radiografia , Recidiva , Tomografia Computadorizada por Raios X
13.
Surg Technol Int ; 28: 222-5, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27175808

RESUMO

Elevated diaphragm can be due to diaphragmatic eventration or diaphragm paralysis. Diaphragm paralysis is a rare condition that can be congenital or acquired. Acquired diaphragmatic paralysis can result from injury to the phrenic nerve. Subsequently, there is loss of contractility of the diaphragm muscle leading to progressive atrophy and, hence, distension of the dome of the diaphragm leading to elevated right, left, or both copula of the diaphragm. Diaphragm plication aims to return the abdominal contents back to their normal position and allow for greater lung expansion by reducing the abundant diaphragmatic surface. Traditionally, diaphragm plication was performed through thoracotomy, until 1996 when Moroux introduced the widely used thoracoscopic technique of diaphragm plication. With the advancement of minimally-invasive surgery over the years, the approach to diaphragm plication has evolved from four ports to an uniportal approach and robotics.


Assuntos
Eventração Diafragmática/cirurgia , Laparoscopia/métodos , Paralisia Respiratória/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Eventração Diafragmática/complicações , Eventração Diafragmática/diagnóstico por imagem , Medicina Baseada em Evidências , Humanos , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/etiologia , Resultado do Tratamento
14.
Ann Thorac Cardiovasc Surg ; 22(4): 224-9, 2016 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-27076066

RESUMO

PURPOSE: There is no data comparing different surgical techniques for diaphragmatic re-positioning for hemi-diaphragmatic eventration in adults. Our aim was to verify the potential pros and cons of two major surgical techniques in symptomatic eventration patients. METHODS: Patients undergoing thoracotomy for diaphragmatic elevation repair either by un-opened (accordion placation) or by opened (double-breasted placation) diaphragmatic technique between January 2007 and August 2013 were analyzed retrospectively, and compared in terms of operative outcomes on 12th and 24th months. RESULTS: Forty-two patients underwent accordion (n = 23) or double-breasted (n = 19) plication. Postoperative drainage was significantly increased (215 ± 66 ml vs. 114 ± 48 ml; P = 0.0082) in double-breasted group. Although the corrected diaphragm was radiologically better preserved in this group, this divergence showed no additional effect on postoperative pulmonary functions or the dyspnea score on 12th or 24th months. No complication particularly related to both techniques or recurrence was noted during follow-up of 28 ± 12 months. CONCLUSIONS: Radiological prospect of corrected diaphragm is better preserved with double-breasted plication, but the significant and permanent improvement of respiratory functions was similar. Since the clinical outcome is equivalent, incision of the diaphragm is not essential.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Técnicas de Sutura , Adulto , Idoso , Diafragma/anormalidades , Diafragma/diagnóstico por imagem , Diafragma/fisiopatologia , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Toracotomia , Fatores de Tempo , Resultado do Tratamento , Capacidade Vital , Adulto Jovem
15.
J Pak Med Assoc ; 66(3): 339-41, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26968290

RESUMO

Thoracic ectopic kidney is a rare developmental anomaly that is the least frequent one among all forms of ectopic kidneys. The condition is generally asymptomatic. If a kidney image is missing on one side in renalor pelvic region in sonographic examination, the possibility of thoracic ectopic kidney should be taken into consideration. For final diagnosis, chest radiography and thorax computerised tomography should be obtained. We herein report a rare case of intra-thoracic kidney accompanied by diaphragm eventration.


Assuntos
Eventração Diafragmática/diagnóstico por imagem , Rim/anormalidades , Tórax/diagnóstico por imagem , Adulto , Feminino , Humanos , Rim/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X
17.
Thorac Cardiovasc Surg ; 64(8): 647-653, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25184611

RESUMO

Objectives The objective of this study was to analyze the clinical respiratory and spirometric effects of video-assisted minithoracotomy diaphragmatic plication (VAM-T DP) in the treatment of diaphragmatic eventration. Methods A retrospective longitudinal study of 18 patients who underwent a VAM-T DP in our service between February 2005 and July 2011 was performed. Data of patient characteristics, preoperative clinical variables, and postoperative results (3, 6, and 12 months) were collected for statistical analysis using the software package SPSS 13.0 for Windows (Wilcoxon test, Friedman test, and Z-test). Results The main clinical respiratory and spirometric variables improved significantly and remained stable over 1 year. Conclusions VAM-T DP is a viable and safe procedure that improves the spirometry values and offers stable results during the first year. To our knowledge, the present series is the second largest published report in English relating to this procedure in adults.


Assuntos
Diafragma/cirurgia , Eventração Diafragmática/cirurgia , Transtornos Respiratórios/cirurgia , Respiração , Paralisia Respiratória/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diafragma/anormalidades , Diafragma/diagnóstico por imagem , Diafragma/inervação , Eventração Diafragmática/diagnóstico por imagem , Eventração Diafragmática/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Transtornos Respiratórios/diagnóstico por imagem , Transtornos Respiratórios/fisiopatologia , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia , Estudos Retrospectivos , Espanha , Espirometria , Cirurgia Torácica Vídeoassistida/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
20.
Am Surg ; 79(9): 893-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24069985

RESUMO

True diaphragmatic eventration is a rare congenital defect that is most commonly asymptomatic, but can result in dyspnea and recurrent respiratory infections. Advancements in endoscopic technology and technique have resulted in minimally invasive methods for repair of this defect with pronounced benefit when compared to the open thoracotomy. We report a case in which a two year old male who suffered from recurrent respiratory infections was found to have unilateral right diaphragmatic eventration that underwent plication utilizing thoracoscopy and cutting endostaplers with Peri-strips. This procedure was followed by a remarkably fast recovery and discharge, improved radiological findings, and a reprieve from respiratory infection.


Assuntos
Eventração Diafragmática/cirurgia , Toracoscopia/métodos , Pré-Escolar , Eventração Diafragmática/diagnóstico por imagem , Humanos , Masculino , Radiografia Torácica , Toracotomia/métodos
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