Delayed-onset Right Diaphragmatic Hernia of Newborn after Group B Streptococcal Pneumonia: A Case Report

新生兒感染B型鏈球菌肺炎後表現的延遲性右側橫膈膜疝氣：病例報告

黃士傑(Shih-Chieh Huang) ； 施焄鏻(Shin-Lin Shih) ； 劉育朋(Yu-Peng Liu) ； 楊斐適(Fei-Shih Yang)

《中華放射線醫學雜誌》 35卷4期 (2010/12) Pp. 237-240

摘要

本篇病例報告是關於一位足月的男嬰，在罹患B型鏈球菌肺炎感染並接受治療之後仍然表現有呼吸窘迫的症狀，腹部超音波只發現肝臟位置偏高，而後經由上消化道鋇劑攝影確認有合併發生延遲性右側橫膈膜疝氣。造成此關聯性的確切機制尚未完全清楚，然而許多患者在胸部X光影像上的表現時常與肋膜積水或其他肺部病灶類似，容易造成臨床診斷上的延遲甚至誤判，若因此讓病患接受不必要的肋膜積水引流甚至可能造成腹腔臟器的損傷。唯有提高對此關聯性的警覺性，方能增加診斷的正確性。

並列摘要

A term, male newborn presented with severe respiratory distress and hypoxia 20 hours after delivery. Group B streptococcal (GBS) sepsis and pneumonia were diagnosed on postnatal day 2, and the patient was treated with antibiotics and mechanical ventilation. Extubation was performed on postnatal day 19, but the baby's respiratory status deteriorated. Herniation of bowel loops into the right thorax was subsequently confirmed by barium study on postnatal day 26. The infant was operated on and recovered. This case illustrates the importance of considering this unusual entity. Early recognition will help avoid dangerous procedures such as thoracentesis, at the same time permitting early treatment that is associated with a good outcome.