General

Case presentaion: A neonate with respiratory distress since birth

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26 Oct 2016 - General
 

 A 13 days old male baby was admitted in the pediatric surgery dept. of DMCH  with the complaints of  respiratory distress since birth and occasional bluish coloration during feeding and crying .There was no history of cough, but mild chest indrawing and sternal recession was present. There was no history of vomiting or nasal frothing. His bowel and bladder habit were normal. 

   Baby was ill-looking, average nutritional status, heart rate-140/min,  respiratory rate-65/min, temp-99 F , wt-3.3 kg. Left side of chest wall bulged anteriorly.

  Movement of the chest diminished on left side, trachea deviated to right, percussion note tympanitic & breath sound diminished on left side. Bowel sound present on left side.

Apex beat noted on right 5th intercostal costal space just medial to the MCL.

•Abdomen was scaphoid shaped, umbilicus was centrally placed, no visible peristalsis. Bowel sound was audible.

NOW, WHAT IS YOUR PROVISIONAL DIAGNOSIS?

 

Thanks for sharing this interesting case. The mentioned symptoms suggest an airy space occupying the left hemi thorax pushing the mediastinal contents towards the right side. I think it is most probably congenital diaphragmatic hernia. Infants with this condition frequently exhibit a scaphoid abdomen, barrel-shaped chest, and signs of respiratory distress (retractions, cyanosis, grunting respirations). In left-sided posterolateral hernia, auscultation of the lungs reveals poor air entry on the l...
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