- 期刊
Congenital Diaphragmatic Hernia Misdiagnosed as Pneumothorax in a Newborn
新生兒先天性橫膈膜疝氣誤診爲氣胸：一病例報告
摘要
大多數先天性橫膈膜疝氣位於左側，且磺膈膜上的缺陷通常大得足以讓腹腔內的器官進行胸腔。在新生兒時期的臨床表現爲呼吸窘迫，在胸部X光可見充氣的胃及腸氣位於缺陷側的胸腔內。此病例爲一新生兒先天性橫膈膜疝氣，X光呈現左胸有一X光透明過度高之囊狀區域，鼻胃管末端位於左橫膈膜下方，而腹部之腸氣分佈看似正常。因病人之呼吸窘迫症關加劇，且當時誤診爲壓力性氣胸，而作細針胸腔穿刺術，症狀得以緩解。新生兒之先天性橫膈膜疝氣，僅有胃部脫出進入胸腔內，爲少見情形，不易診斷。在X光片上看不到左上腹有胃部充氣，以及超音波下找不到位於腹腔內之胃部，是對此少見表現之重要診斷依據。
並列摘要
Congenital diaphragmatic hernia (CDH) is usually left sided and has a large defect allowing abdominal viscera herniated into thoracic cavity. The chest films usually show air-filled stomach and/or loops of bowel in the ipsilateral hemithorax with mediastinal shift. We report a newborn with CDH, presenting as hyperlucent hemithorax, right-shifted mediastinum, apparently normal pattern of abdominal bowel gas, with the tip of naso gastric tube below the left hemidiaphragm on the radiograph. It was initially misdiagnosed as pneumothorax, and the acute respiratory distress was temporarily relieved by needle aspiration. Hyperlucent hemithorax due to intrathoracic gastric dilatation alone is an unusual presentation of CDH in neonatal period. Absence of stomach bubble in the left upper quadrant of the abdomen, in both radiography and abodominal sonography, is an important clue to make diagnosis of CDH in this misleading condition.
延伸閱讀
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