Darlington C Danny, Anitha G Fatima Shirly
Department of Urology, Stanley Medical College, Chennai, Tamil Nadu, India.
Department of Pediatrics, CSI Kalyani Hospital, Chennai, Tamil Nadu, India.
Indian J Crit Care Med. 2017 Jun;21(6):394-396. doi: 10.4103/ijccm.IJCCM_83_17.
Congenital diaphragmatic hernia (CDH) usually presents in the neonatal period, and about 10% of reported cases occur in adults. The most common type is Bochdalek's hernia, which occurs through a defect in the posterolateral portion of the diaphragm with an estimated prevalence of 1 in 2500 live births. CDH in adults presents with gastrointestinal or respiratory symptoms, which can be acute or intermittent. We report a case of CDH diagnosed in a 55-year-old man, who presented with acute onset of chest pain and dyspnea with insignificant past history. This patient was initially evaluated medically for myocardial infarction followed by intercostal chest drainage placement, before a definitive diagnosis of CDH was made. This case is reported for its rarity and to highlight the high index of suspicion needed to diagnose CDH in adulthood. This is specially important as CDH, masquerades as other acute conditions in older individuals thereby delaying the diagnosis.
先天性膈疝(CDH)通常在新生儿期出现,约10%的报告病例发生在成人。最常见的类型是博赫dalek疝,它通过膈肌后外侧部分的缺损发生,估计在2500例活产中发生率为1例。成人CDH表现为胃肠道或呼吸道症状,可为急性或间歇性。我们报告一例在一名55岁男性中诊断出的CDH病例,该患者表现为急性胸痛和呼吸困难,既往史不显著。该患者最初接受心肌梗死的医学评估,随后进行肋间胸腔引流置管,然后才做出CDH的明确诊断。报告此病例是因其罕见,并强调在成年期诊断CDH所需的高度怀疑指数。这一点特别重要,因为CDH在老年人中会伪装成其他急性疾病,从而延迟诊断。