O’Farril AR, Molina RD

Language: Spanish
References: 20
Page: 225-229
PDF size: 145.93 Kb.

ABSTRACT

Objective: To describe the case of a patient with diaphragmatic eventration secondary to a thorax trauma, its analysis and surgical resolution.
Setting: Third level health care hospital.
Design: Description of the case.
Description of the case: Man of 41 years of age with an antecedent of trauma to the right hemithorax during adolescence for which a thoracotomy was performed to resolve a hemothorax. He starts to complain of large effort dyspnea a year ago, accompanied by oppressive pain in the right hemithorax. Extension studies revealed elevation of the right hemidiaphragm; the CAT scan and NMRI corroborated right hemidiaphragm eventration with compression of cardiac cavities. Electromyography revealed hypomobility of the diaphragm, the echocardiogram revealed dilatation of the pulmonary trunk, pulmonary and tricuspid valve failure, as well as compression of right extrinsic cavities. Resting arterial gasometry was normal and during exercise it revealed severe hypoxemia: spirometry with moderate pulmonary restriction. The patient was subjected to a Mayo-type diaphragmatic repair and strengthening of the suture line with polytetrafluoroethylene mesh (ePTFE).
Conclusion: Diaphragmatic eventrations can occur in patients with antecedents of thoracic trauma, having respiratory insufficiency as the sole clinical manifestation. Surgical treatment consisted of diaphragmatic plication and strengthening with synthetic mesh.

REFERENCES

1. Bisgard JD. Congenital eventration of the diaphragma. J Thorac Surg 1947; 16: 484-491.

2. McNamara JJ, Paulson DL, Urschel HC Jr, Razzuk MA. Eventration of the diaphragm. Surgery 1968; 64:1013-1021.

3. Thomas TV. Congenital eventration of the diaphragma. Ann Thorac Surg 1970; 10:180-192.

4. Chin EF, Lynn, RB. Surgery of eventration the diaphragma. J Thorac Surg 1956; 32: 6-14.

5. Navarro-Nuño I, Fuller C, Holmes L. Acquired diaphragmatic eventration in an adult. Contemp Surg 2000; 56: 557-561.

6. Morales-Guzmán O, Ávila-Ramírez E. Diagnóstico gammagráfico de alteraciones diafragmáticas en niños. Bol Med Hosp Infant Mex 1978; 35: 225-234.

7. Belio-Castillo C, Blanco-Rodríguez G, Rodríguez-Paredes H. Eventración diafragmática. Experiencia de 50 casos. Bol Med Hosp Infant Mex 1992; 49: 291-295.

8. Rodríguez-Balderrama I, Reyes-Fernández MO, Cisneros-García N, Rodríguez-Bonito R, Ibarra-Rodríguez JA, Zárate-Gómez M. Hernia diafragmática secundaria a lesión del nervio frénico al nacimiento. Bol Med Hosp Infant Mex 1993; 50: 191-193.

9. Moinuddeen K, Baltzer JW , Zama N . Diaphragmatic eventration: an uncommon presentation of a phrenic nerve schwannoma. Chest 2001; 119: 1615-6.

10. Weber TR, Tracy TF Jr, Silen ML. The diaphragm: developmental, traumatic and neoplastic disorders. In: Glenn’s Thoracic and Cardiovascular Surgery. 6th ed. Stamford, CT: Appleton & Lange, 1996: 618-619.

11. Carrilo-Esper R, Gargallo-Hernández JJ, Hernández-Vásquez R, Domínguez-Rodríguez I, Ramírez-Hernández JM. Eventración diafragmática. Gac Méd Mex 1998; 134: 617-618.

12. Watanabe S, Shimokawa S, Fukueda M, Kinjyo T, Taira A. Large eventration of diaphragm in an elderly patient treated with emergency plication. Ann Thorac Surg 1998; 65: 1776-7.

13. Tsukahara Y, Ohno Y, Itakura A, Mizutani S. Prenatal diagnosis o congenital diaphragmatic eventration by magnetic resonance imaging. Am J Perinatol 2001; 18: 241-244.

14. Simansky Aley M, Rafaely Y, Yellin A. Diaphragm plication following phrenic nerve injury: a comparison of paediatric and adult patients. Thorax 2002; 57: 613-616.

15. Knight SR, Clarke CP. VATS plication of diaphragmatic eventration. Ann Thorac Cardiovascular Surg 1998; 4: 240-243.

16. Marinelli PV, Ortiz A, Alden SR. Acquired eventration of the diaphragm: a complication of chest tube placement in neonatal pneumothorax. Pediatrics 1981; 67: 552-554.

17. Gatzinzky P, Lepore V. Surgical treatment of large eventration of the left diaphragm. Eur J Cardiothorac Surg 1993; 7: 271-274.

18. Hood M, Boyd A, Culliford A. Thoracic trauma. In: Injuries involving the diaphragm. W.B. Saunders Company, 1989: 267-289.

19. Sasaki F, Koga S, Takeuchi A. A case of partial eventration of the right diaphragm simulating a mediastinal tumor. Rinsho Hoshasen 1985; 30:125-127.

20. Mouroux J, Padovani B, Poirier NL, Benchimol D, Bourgeon A, Deslauriers J, et al. Technique for the repair of diaphragmatic eventration. Ann Thorac Surg 1996; 62: 905-907.