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Case Reports
. 2010 Jan;45(1):265-8.
doi: 10.1016/j.jpedsurg.2009.10.090.

Hepatic pulmonary fusion in an infant with a right-sided congenital diaphragmatic hernia and contralateral mediastinal shift

Jeffrey W Gander  1 , Angela Kadenhe-Chiweshe, Jason C Fisher, Brooke S Lampl, Walter E Berdon, Charles J Stolar, Jeffrey L Zitsman
Affiliations
Case Reports

Hepatic pulmonary fusion in an infant with a right-sided congenital diaphragmatic hernia and contralateral mediastinal shift

Jeffrey W Gander et al. J Pediatr Surg. 2010 Jan.

Abstract

Hepatic pulmonary fusion is extremely rare with only 9 previous cases reported in the literature. In typical cases, the clinician should be alerted to the possibility of hepatic pulmonary fusion if the chest radiograph shows a large opacity on the right side without a contralateral mediastinal shift. The authors present a case of right-sided diaphragmatic hernia and hepatic pulmonary fusion with associated contralateral mediastinal shift discovered beyond the neonatal period. The 9 previous cases were retrospectively reviewed with special attention to mediastinal shift on preoperative chest radiograph, operative procedure, and mortality. Only one previous case demonstrated a contralateral mediastinal shift. The most common procedure performed was partial separation of the hepatic pulmonary fusion and approximation of the diaphragmatic defect. Four of the previous 9 patients died. In our case, reduction of bowel and approximation of the diaphragmatic defect around the fused liver and lung have been successful.

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Figures

Figure 1
Figure 1
Figure 1A – Chest radiograph at time of presentation demonstrated a right sided diaphragmatic hernia with bowel in right chest and contralateral mediastinal shift. Black asterisk denotes liver in thorax. Figure 1B – Coronal magnetic resonance image of patient’s chest. In right chest, liver is seen herniating and area of fusion to underdeveloped right lung is denoted by white arrow.
Figure 2
Figure 2
Figure 2A – View from abdomen. Black arrow denotes site of hepatic pulmonary fusion. White arrows show border of diaphragmatic defect. White asterisk on lung and black asterisk on liver. Retractor is seen at right side of image. Figure 2B – After approximation of diaphragmatic defect. Black asterisk is liver, black arrow is PTFE mesh and white arrow is polyester fiber mesh connecting liver to the PTFE patch.
Figure 3
Figure 3
Post operative chest radiograph demonstrating bowel contents reduced into the abdomen. Black asterisk denotes liver persistently in right chest.
See this image and copyright information in PMC

References

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