2.3 - Case progression
Recurrent tachypnea and respiratory distress on Day 12 of life was
treated with CPAP after which the tachypnea and tachycardia improved. A
follow up chest X-ray 12 hours after CPAP initiation showed persistent
elevation of left diaphragm with a round lucency in the lung. Two days
after restarting CPAP, the team attempted to wean pressures but the baby
did not tolerate this, with increased tachypnea. After another 2 weeks
of support he was successfully weaned to room air. During this time, he
had a normal head ultrasound and echocardiogram. A chest ultrasound was
non-diagnostic for eventration while on CPAP. A chest CT (Figure 3),
conducted at the peripheral hospital, was reported to show a possible
left posterior diaphragm eventration or hernia and a right posterior
hemithorax lesion separate from the liver.
Figure 3: Unenhanced CT chest and abdomen coronal
reconstruction: Elevated hemidiaphragms bilaterally. Sigmoid colon and
left kidney are in the left hemithorax, with a posterior diaphragmatic
eventration or hernia. The right kidney is in the right hemithorax, with
a posterior diaphragmatic eventration or hernia.