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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many patients with illnesses that once were fatal at birth or during childhood now survive into adult life. This article considers four respiratory illnesses of early life in which long-term survival now occurs frequently: cystic fibrosis, diaphragmatic hernia, esophageal atresia-tracheoesophageal fistula, and bronchopulmonary dysplasia. In cystic fibrosis, although the median age at death is now 25 years, chronic pulmonary infection due ultimately to the abnormal composition and clearance of airway mucus is still the usual cause of death. Earlier survivors of congenital diaphragmatic hernia had only minor diminution of perfusion and ventilation of the lung on the side of the hernia as adolescents or young adults; however, as infants with greater degrees of pulmonary hypoplasia have successful repair of their hernias, more long-term respiratory impairment will probably be found. The esophageal atresia tracheoesophageal fistula complex leaves all esophagi and many tracheas permanently abnormal; recurrent aspiration, repeated pneumonia, and an unduly collapsible trachea are the result, although symptoms may be few. Survivors of bronchopulmonary dysplasia have decreased exercise capacity, wheezing, and recurrent pneumonia, although their chest radiographs may become normal or almost normal.
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PMID:Caldwell Lecture. Respiratory problems of early life now allowing survival into adulthood: concepts for radiologists. 835 26

A 3-year-old child presented to the emergency department (ED) with the sudden onset of shortness of breath and wheezing. The child had previously been in good health and had no problems during the neonatal period. Chest x-ray performed in the ED was consistent with a Bochdalek diaphragmatic hernia. Subsequently, the child had surgery. The diagnosis was confirmed, and recovery was uneventful. The differential diagnosis of late onset congenital diaphragmatic hernia is discussed with an emphasis on both early recognition and differential diagnosis of this rare but correctable entity.
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PMID:Delayed-onset Bochdalek hernia in a 3-year-old child. 317 53

A child with a past history of wheezing presented with an acute illness that simulated an asthma attack. Respiratory distress was not alleviated by nebulized and parenteral therapy for status asthmaticus. The diagnosis of posterolateral diaphragmatic hernia became obvious only when a radiograph demonstrated gas-filled loops of bowel in a hemithorax. The clinician must entertain the diagnosis of congenital diaphragmatic hernia in patients with apparent bronchospasm.
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PMID:Herniation of abdominal contents simulating status asthmaticus. 343 99

When infants with recurrent wheezing have a clinical course inconsistent with asthma, an extensive list of alternative diagnoses needs to be considered. Anatomic malformations, such as congenital heart disease, laryngotracheomalacia, and diaphragmatic hernia, should be considered for immediate medical stabilization and early surgical correction. Life-threatening infections such as bacterial epiglottitis, retropharyngeal cellulitis, and viral myocarditis require prompt intervention. A careful history and physical examination reveal important diagnostic clues that, in this case, prompted a directed evaluation to rule out common masqueraders of asthma such as foreign body aspiration, cystic fibrosis, gastroesophageal reflux, viral pneumonitis, or pulmonary tuberculosis. On occasion, such a search is unrevealing and a diagnostic challenge remains. In those situations, judicious use of modern technology to scrutinize anatomic (high-resolution computed tomography) and functional (infant pulmonary function tests) pathology, and justifiable invasive procedures such as bronchoscopy and lung biopsy, uncover the true diagnosis, allowing for optimal management.
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PMID:A wheezy infant unresponsive to bronchodilators. 916 57

Foregut cysts frequently cause symptoms in the first three decades of life. The symptoms consist of dyspnea, wheezing, cough and sputum, dysphagia, stridor, and those associated with right heart strain. Symptoms and the radiological appearance of the uncomplicated cyst mimic mediastinal tumour and mediastinal obstruction. The symptoms and radiological appearance of the ruptured infected cyst simulate those of lung abscess, diaphragmatic hernia, ruptured hydatid cyst, cavitated peripheral carcinoma and pulmonary tuberculosis. In this series the differentiation from other cysts was made thus: with intralobar sequestration, a systemic arterial blood supply was demonstrated; with hydatid cyst, there was a positive intradermal skin test and (radiologically) following rupture, the appearance of a pericystic pneumatocele followed by the water-lily sign was diagnostic; with emphysematous cysts, the signs of associated bronchitis were present; in the presence of pseudocysts, there was a previous history of lung abscess, staphylococcal infection or tuberculosis. Cysts should be removed when first diagnosed.
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PMID:Foregut cysts. 1397 21

A 23-year-old man presented with a long history of dyspnea and wheezing thought to be due to asthma. Abnormal appearance of the left hemithorax was an incidental finding on a chest X-Ray. On further investigations he was found to have congenital Bochdalek hernia which was repaired surgically. All his respiratory symptoms resolved and he was able to discontinue treatment for asthma. We want to emphasise that late presentations can be misleading even to an astute clinician.
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PMID:Late presentation of congenital Bochdalek hernia: a case report. 1713 Mar 34

We report a case of a late-presenting congenital diaphragmatic hernia (CDH) in an otherwise healthy infant initially presenting to the emergency department with wheezing and respiratory distress. Late-presenting CDH can manifest a vast array of clinical symptoms and therefore may frequently masquerade as other more common pediatric entities. Prompt and accurate diagnosis is essential in the management of late-presenting CDH; patients may be critically ill at presentation, and selection of appropriate therapeutic interventions may avoid potentially life-threatening complications. In this case report, we seek to inform emergency physicians about this rare, but serious, disorder.
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PMID:Late-presenting congenital diaphragmatic hernia mimicking bronchiolitis. 1787 58

Many children are brought to the emergency department because of respiratory symptoms including wheezing. Asthma is the most common but not the only cause of wheezing in children. There are many conditions, both pulmonary and extrapulmonary, which may cause recurrent wheezing. The diagnosis in children with congenital diaphragmatic hernia may be delayed. The late presentation of congenital diaphragmatic hernia poses a considerable diagnostic challenge. We report an 18-month-old child with congenital diaphragmatic hernia who presented with recurrent respiratory symptoms and localized physical findings. This case underscores the need to consider alternative diagnoses including congenital diaphragmatic hernia in the evaluation of recurrent respiratory symptoms; this is especially true if the presentation is not consistent with asthma or there are asymmetric findings on auscultation.
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PMID:A wheezing child: breath sounds or bowel sounds? 1849 14

Congenital diaphragmatic hernia (CDH) presents a wide spectrum of anatomical variants and clinical pictures depending on the topography and dimensions of the diaphragmatic defect and on the patient age. Most CDH cases acutely present with tachypnea, cyanosis, and respiratory failure within the first minutes to hours of life. Despite significant advances in neonatal medicine, this congenital anomaly still presents a high mortality rate, especially for associated malformations. On the other hand, there is a rare subset of CDH patients who present outside the neonatal period. The most common symptoms of late-presenting CDH include recurrent pulmonary infections, dyspnea, wheezing, abdominal pain, failure to thrive, vomiting, diarrhea and anorexia. Although late-presenting CDH generally presents good prognosis after early surgical correction, misdiagnosis is quite frequent because of its wide spectrum of clinical manifestations. The following case report describes a six-month-old infant presenting with acute respiratory distress and vomiting caused by late-presenting left-sided CDH.
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PMID:Acute respiratory distress for late-presenting congenital diaphragmatic hernia. 1910 55

A number of questions must be asked before asthma can be accepted as a valid diagnosis: were the episodes of shortness of breath investigated? Are there changes at autopsy in keeping with asthma? Did asthma either contribute to the terminal episode, cause death, or was it coincidental? Finally, is it possible that other conditions may have accounted for the clinical manifestations? A review of files at FSSA over a 10-year period from 1999 to 2008 identified six cases where shortness of breath and/or wheezing had been incorrectly attributed to asthma. Five were due to pulmonary thromboembolism and one to multiple injuries. In the latter case, an irreducible, left-sided diaphragmatic hernia was present. There was no morphological evidence of asthma in any case. Autopsy examination may, therefore, be crucial in revealing other conditions that may have caused or contributed to episodic breathlessness that may have been incorrectly attributed to asthma.
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PMID:All that wheezes is not asthma--Alternative findings at autopsy. 2073 97


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