正常胸部レ線像を呈した後に発症した右横隔膜ヘルニアの1例

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A patient with delayed presentation of right-sided diaphragmatic hernia was reported. This patient was a boy who had operation for gastric rupture at 3 days of age. He had been on mechanical ventilation for 3 days postoperatively. Chest x-ray taken during this period showed no abnormality. On the 6th postoperative day, when he developed cyanosis suddenly, chest x-ray disclosed atelectasis of the right upper lobe and infiltrate of the right lower lobe. A diagnosis of right diaphragmatic hernia was made on day 41 by the findings of repeated chest x-rays, ultrasonography, and liver scintigram. Thoracotomy performed at 53 days of life disclosed a 8X7cm right-sided diaphragmatic hernia with herniation of a right lobe of the liver. The defect was repaired with uneventful recovery. This case suggests the following conclusion: 1. A previously normal chest x-ray does not necessarily preclude the presence of congenital diaphragmatic hernia. 2. When a chest x-ray shows an abnormal shadow in the lower lobe after an abdominal operation or mechanical ventilation, the possibility of congenital diaphragmatic hernia should be considered.
1988-06-20