Pediatric emergency medicine trisk 4109 4109

FIGURE 124.12 A 4-year-old boy admitted with 1-day history of recurrent severe upper abdominal colicky pain with dyspnea and decreased breath sounds in the left base Posteroanterior (A ) and lateral (B ) chest films demonstrate multiple bowel loops in the lower, posterior, left side of chest, indicative of a foramen of Bochdalek hernia that was subsequently repaired without difficulty Diaphragmatic Eventration Eventration is an abnormal elevation of one or both hemidiaphragms, and may present to the emergency clinician as an unexpected finding on a chest radiograph obtained for another reason Eventration may be congenital or acquired Acquired diaphragmatic eventration is commonly the result of a phrenic nerve paralysis, which may be caused by birth, operative, or other trauma Neoplastic or inflammatory processes in close proximity to the phrenic nerve can also lead to eventration Diaphragmatic eventration occurs most commonly on the left side, but may be bilateral The affected hemidiaphragm moves paradoxically during inspiration and expiration, with compromise of pulmonary mechanics and function A large enough congenital eventration may affect prenatal and postnatal lung development, potentially resulting in pulmonary hypoplasia Clinical Recognition