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Case Reports
. 2018 Jan;6(1):e63-e65.
doi: 10.1055/s-0038-1667357. Epub 2018 Aug 22.

Congenital Diaphragmatic Hernia Presenting with Tension Pneumothorax in a 3-Year-Old Boy

Maren Friederike Balks  1 , Jan-Hendrik Gosemann  1 , Ina Sorge  2 , Martin Lacher  1 , Franz Wolfgang Hirsch  2
Affiliations
Case Reports

Congenital Diaphragmatic Hernia Presenting with Tension Pneumothorax in a 3-Year-Old Boy

Maren Friederike Balks et al. European J Pediatr Surg Rep. 2018 Jan.

Abstract

We report the case of a 3-year-old boy who presented with an upper respiratory tract infection and severe dyspnea. A chest X-ray revealed a left-sided tension pneumothorax with mediastinal shift and suspected enterothorax. After thoracic computed tomography (CT) scan, a chest tube was inserted, which drained fluid which had the same consistency and color as the one derived from the nasogastric (NG) tube. The boy underwent diagnostic laparoscopy for suspected bowel perforation, which confirmed a left-sided Bochdalek hernia with herniation of the viscera into the chest. After repositioning of the herniated organs into the abdomen, a gastric perforation was identified and repaired. This case demonstrates that the cause of a tension pneumothorax in an infant may be a rare combination of congenital diaphragmatic hernia (CDH) and perforation of a visceral hollow organ.

Keywords: congenital; diaphragmatic; hernia; pneumothorax; tension.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
Chest X-ray at presentation (this image is provided by courtesy of Pediatric Clinic, Fachkrankenhaus Hubertusburg, Wermsdorf, Sachsen, Germany).
Fig. 2
Fig. 2
Thoracic CT scan on admission: left-sided tension pneumothorax with mediastinal shift. No further signs of a traumatic etiology.
Fig. 3
Fig. 3
Chest X-ray at 1-year of age with no signs of diaphragmatic hernia.
Fig. 4
Fig. 4
Diagnostic laparoscopy: herniation of stomach, spleen and bowel into the chest.
Fig. 5
Fig. 5
Gastric perforation after repositioning of herniated organs into the abdomen.
See this image and copyright information in PMC

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