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.