The bochdalek hernia, also known as a posterolateral diaphragmatic hernia, is the most common manifestation of cdh, accounting for more than 95% of cases. Management of incidental bochdalek hernia in an asymptomatic. Imaging studies on emergency room presentation demonstrated a large herniation of viscera into her chest occupying her entire left chest with. Bochdalek hernia is a type of congenital diaphragmatic hernia cdh, which more commonly affects children. The physical characteristics of incidental or latepresenting bochdalek s hernia may confound diagnosis of findings at physical examination or chest radiology, specifically a higherthanpreviouslythought incidence of rightsided bochdalek s hernia. Bochdalek hernias are one of the most common congenital abnormalities encountered in imaging studies of the chest and abdomen. The rarity of this hernia and its nonspecific presentation leads to delay in the diagnosis, with the potential risk of complications. Bochdalek hernias constitute 90% of congenital diaphragmatic hernias and are more common on the left side. Bochdalek hernia is a type of congenital diaphragmatic hernia cdh that typically presents in childhood. In rightsided bochdalek hernias, the contents were hepar, ren, colon transversum, and omentum majus. An interesting case of bochdalek hernia medical dialogues. One child experienced a complicated course when the x ray picture was misinterpreted as. The diaphragm is the major muscle of respiration and the second most important muscle within the body after the heart.
Most bochdaleks hernias are diagnosed in children, ranging from neonates through preschoolers, who present with clinical symptoms caused. A bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being morgagni hernia. Most bochdalek hernias are diagnosed in children who present with acute pulmonary symptoms. Demographics and etiology congenital there are two main types. Bochdalek hernia occurs from a congenital defect of the diaphragm, allowing the passage of abdominal structures into the thoracic cavity, limiting lung expansion and ventilatory function. Congenital diaphragmatic hernia cdh is a birth defect of the diaphragm.
Ct typically demonstrates the diaphragmatic defect with abdominal. In addition to separating the organs of chest from the organs of the abdomen, the diaphragm also. Bochdalek hernia is the most common type of congenital diaphragmatic hernia. Bochdalek hernia is a congenital posterolateral diaphragmatic defect that is a result of failed closure of the pleuroperitoneal ducts a primitive communications between the. Pearls and pitfalls in thoracic imaging cambridge core.
Ab imaging description a bochdalek hernia is a defect of the posterior hemidiaphragm with protrusion of abdominal content, usually fat, into the thorax 1. It may occur on either side, but is more common on the left side due to a protective barrier effect of the liver 1, 2. A posterior bochdalek hernia likely represents a developmental defect of the pleuroperitoneal folds or failure of fusion of the folds and transverse septum with the intercostal muscles. The aircontaining structure is seen posteriorly on the lateral view red arrow. Adult presentation of bochdalek hernia is uncommon. Posterolateral bochdalek diaphragmatic hernia in adults. Bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. Symptomatic bochdalek hernias in adults are relatively rare but may lead to incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease. Adult bochdalek herniaclinical features, management and. Bochdalek hernia is the most common form of diaphragmatic hernia. There are fewer than 20 cases of rightsided bochdalek hernia reported in adults in the literature. Discuss the embryology and anatomy of the diaphragm and the origin of diaphragmatic hernias.
Congenital diaphragmatic hernias knowledge for medical. Bochdalek hernia is a cause of respiratory distress in the newborn baby. The aim of this study was to summarize clinically relevant data for the purpose of assisting surgeons with the workup, diagnosis, and treatment of adult patients with bochdalek hernia. Diaphragmatic hernias are defined as either congenital or acquired defects in the diaphragm. Bochdalek s hernia is not rare, and the incidence of bochdalek s hernias that contain enteric tract is higher than previously reported. Bochdalek hernia is a posterolateral diaphragmatic defect resulting from failure of the retroperitoneal canal membrane to fuse with the dorsal esophageal mesentery and the body wall. This incidence likely represents a conservative estimate because some bochdalek s hernias may have been overlooked or unreported. Retroperitoneal structures may prolapse through the defect, e. Congenital hernias resulting from a developmental failure of posterolateral diaphragmatic foramina to fuse properly were first described by bochdalek in 1848, although the origins of descriptions of diaphragmatic hernia can be dated to writings of 1690. In this instance the diaphragm abnormality is characterized by a hole in the posterolateral corner of the diaphragm which allows passage of the abdominal viscera into the chest cavity. Bochdalek hernia may occur if there is delayed or incomplete closure of the embryonic pleuroperitoneal membrane during the seventh week of gestation.
Cardiac radiology genitourinary radiology learning radiology. Nov 23, 2009 bochdalek hernia is a type of congenital diaphragmatic hernia that typically presents in childhood the clinical manifestation of symptoms and diagnosis in adults is extremely rare. Bochdalek hernia 3cm in50yr old female any treatment. Bochdalek hernias usually present in neonates with respiratory failure, need to be operated early and are associated with a high mortality. Laparoscopic repair of bochdalek diaphragmatic hernia in. Bochdalek herniae may mimic diaphragmatic rupture from trauma, but you would expect to find other supportive signs of chest andor abdominal trauma. Frontal view of the chest shows a large aircontaining and walled structure in the region of the left lower lobe white arrow. Leftsided hernias were found approximately twice as often as rightsided hernias. Bochdalek hernias occur in approximately one in every two thousand two hundred to twelve thousand five hundred births yearly.
Oct, 2017 bochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. The majority of these patients presented as acute surgical emergencies and a lack of awareness of this condition lead to an incorrect diagnosis in 38 per cent. Imaging findings of adult bochdalek hernias sciencedirect. This incidence likely represents a conservative estimate because some bochdaleks hernias may have been overlooked or unreported. Bochdalek hernia, strangulation, adult, rightsided background bochdalek hernia is a diaphragmatic hernia usually diagnosed during the neonatal period. Bochdalek hernia is a congenital posterolateral diaphragmatic defect that is a result of failed closure of the pleuroperitoneal ducts a. Presentation, demographics, and surgical management of. The 2 most common types of diaphragmatic hernia are. The majority of these cases are incidental, asymptomatic posterolateral diaphragmatic defects. We present the case of a 50yearold female han patient with tremendous leftsided congenital posterolateral diaphragmatic hernia bochdalek hernia who also has a pair of supernumerary breasts and pulmonary hypoplasia of the lowerleft lobe. Symptomatic cases of bochdaleks hernia in adults are fairly rare, although case studies are found in the literature.
In this article, we report a case of a 30yearold male with leftsided bochdalek hernia who was. Bochdalek hernia affects approximately 1 in 2200 to 12,500 live births and was first described by vincent alexander bochdalek in 1848. Laparoscopic adult bochdalek hernia repair with mesh. Bochdalek hernia is a type of congenital diaphragmatic hernia that primarily manifests in children. Congenital diaphragmatic hernia is estimated to occur in up to 1 in 2000 births. Bochdalek hernia in a symptomatic adult the annals of. We describe an adult patient who came to the emergency department with nonspecific recurrent chest and abdominal pain. Congenital diaphragmatic hernia cdh is a birth defect of the diaphragm resulting in. The bochdalek hernia is a much more common congenital anomaly in the asymptomatic adult than previously thought and frequently can be identified on routine chest and abdominal ct images. Symptomatic adults are diagnosed rarely, with the majority of. It typically occurs in the left hemidiaphragm and presents with severe respiratory and circulatory compromise. If defective development, diaphragmatic hernia develops.
In this case the diagnosis was a bochdalek hernia, also known as a posterolateral diaphragmatic hernia or. Bochdalek hernia bh is an uncommon form of diaphragmatic hernia. There are no robust studies that reveal the true natural history of this disease process. As such, symptoms typically manifest in the pediatric age group and tend to be respiratory. In this article, we report a case of a 30yearold male with leftsided bochdalek hernia who was incidentally diagnosed on chest radiograph. Approximately twenty percent of those with a bochdalek hernia also have a congenital heart defect. It rarely occurs in adults and most of them are asymptomatic. They occur posteriorly and are due to a defect in the posterior attachment of the diaphragm when there is a failure of pleuroperitoneal membrane closure in utero. A bochdalek hernia develops when abdominal organs push through a defective location of the diaphragm and protrude into the thoracic cavity.
Postnatal diagnosis is confirmed on a chest xray which reveals abdominal. Bbbbb is a simple mnemonic to recall the features of bochdalek hernias. Kocakusak and others reported a case of a 21yearold male with a leftsided. In the leftsided bochdalek hernias, the contents were gaster, caecum, appendix vermiformis, colon ascendens and transversum.
Rarely, incarceration of hernia content may occur 3. Jan 14, 2016 less commonly, herniation occurs through the pleuroperitoneal hiatus bochdalek hernia or the parasternal hiatus morgagni hernia. The patient had an unevent ful post operative period and was well at 6 months followup. Ct images show a defect of the right crus of the diaphragm with herniation of the stomach, the first part of the duodenum and part of the left lobe of the liver into the right hemithorax. Bochdalek hernias are congenital diaphragmatic defects that have been well described in the pediatric literature. May 30, 2011 bochdalek hernia is a type of congenital diaphragmatic hernia that primarily manifests in children. It occurs when there is a weakness in the diaphragm, the muscle that divides the chest cavity from the abdominal cavity.
A bochdalek hernia is through a weakness in the diaphragm, and usually occurs on the left. Prevalence of incidental bochdaleks hernia in a large. The first congenital diaphragmatic hernia was described in the 17th century by lzarus riverius and first described clinically by vincent alexander bochdalek in 1848. Bilateral bochdalek hernias presenting as respiratory. Bochdalek hernia is a congenital anomaly in neonatal and postnatal patients and occurs in about one in 2,200 to 12,500 live births, but it is rare in adults. Ct scout image reveals indistinct right diaphragmatic copula with right paracardiac soft tissue shadow.
Bochdalek hernia affects approximately 1 in 2200 to 12,500 live births and was first described by vincent alexander bochdalek in 1848 3. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Two axial images from a contrastenhanced ct of the abdomen reveal a fatty density protruding through a rent in the posterior aspect of the right hemidiaphragm. Bochdalek hernias are a very rare form of diaphragmatic hernias. Even more rare is the diagnosis of a rightsided bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases. The density represents omental fat which has herniated through a small bochdalek hernia. Bochdalek hernia is common in neonates but rarely occur in adults. Large hernias are a different story, and may need surgical repair by a. A computed tomography scan showed a large posterolateral diaphragmatic defect and an oversized spleen. It appears frequently in infants but rarely in adults.
Prevalence of incidental bochdaleks hernia in a large adult. Morgagni hernias are one of the congenital diaphragmatic hernias cdh, and is characterized by herniation through the foramen of morgagni. Bochdaleks hernia definition of bochdaleks hernia by. A hernia is defined as the protrusion of an organ through an opening located on the structure that contains the organ. Symptomatic cases of bochdalek s hernia in adults are fairly rare, although case studies are found in the literature. Laparoscopic repair of bochdalek diaphragmatic hernia in adults. By far the most common is a hiatal hernia the stomach slips through the esophageal hiatus into the chest. Although treatment has progressed through the use of thoracoscopic repair in 1995 and laparoscopic.
Because the body relies so much on the diaphragm for respiratory function, understanding how many different diseases processes ultimately result in dysfunction of the diaphragm is vitally important. Diaphragmatic hernia in children health encyclopedia. When compared to bochdalek hernias, morgagni hernias are. In contrast, diagnosis of a bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm.
The vast majority of bochdalek hernias occurring in adults are inconsequential 1, 2. Newborns may present with respiratory distress at birth similar to a bochdalek hernia. A bochdalek hernia also known as a posterolateral diaphragmatic or a pleuroperitoneal hernia is a congenital diaphragmatic hernia. We herein present 2 cases of adult bochdalek hernia. The etiology can be congenital, due to alterations in diaphragm development, or acquired as the result of surgery, trauma, or infection. The most common cdh presenting in adults is bochdalek hernia, with prevalence in the adult population ranging from 0. Lack of familiarity with the typical imaging appearance of a bochdalek hernia may lead to unnecessary work up as it may be mistaken for an indeterminate mass or diaphragmatic injury. We present a case of an 88yearold woman with severe hypoxia and respiratory. Congenital left diaphragmatic hernias, such as bochdalek, rarely occur in adults. These types of congenital diaphragm hernias are commonly seen on abdominal ct scans done for other reasons, and are usually not dangerous, as they have typically been present for many years, cause no symptoms, and only contain a small amount fat so are not at risk to become strangulated.
Gale reported an incidence of 6 per cent in 940 adults who had chest and abdominal ct examinations. Prevalence of incidental bochdalek s hernia in a large adult. Xiaofeng hu at department of radiology, anhui provincial hospital, hefei, china, and colleagues have reported an interesting case of a bochdalek hernia that has appeared in lancet. In contrast to the acute presentation by infants with these hernias, most adults present with more chronic symptoms, such as chronic dyspnoea. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. Bochdalek hernia article about bochdalek hernia by the. There are 3 types of diaphragmatic hernia that may be seen in cxr. Malformation of the diaphragm allows the abdominal organs to push into the chest cavity, hindering proper lung formation cdh is a lifethreatening pathology in. Bochdalek hernias have been reported to occur more commonly on the left side, although a recent small series described a rightsided predominance 68% with bilateral involvement in 14% of affected patients. A bochdalek hernia is a congenital abnormality in which an opening exists in the infants diaphragm, allowing normally intraabdominal organs particularly the stomach and intestines to protrude into the thoracic cavity. From five to sixteen percent will have some type of chromosomal abnormality along with a bochdalek hernia. A hernia may develop in various parts of the body, most commonly in the region of the abdomen. Bochdaleks hernia is not rare, and the incidence of bochdaleks hernias that contain enteric tract is higher than previously reported.
Giant congenital diaphragmatic hernia in an adult journal. Congenital diaphragmatic hernia learning radiology. The stomach, liver, spleen, or intestines move up into your childs chest cavity. Bilateral bochdalek hernias presenting as respiratory failure. Radiological diagnosis of congenital diaphragmatic hernia in 17th. Also see our learning card acquired diaphragmatic hernias. Less commonly, herniation occurs through the pleuroperitoneal hiatus bochdalek hernia or the parasternal hiatus morgagni hernia. In china, all pregnant women undergo ultrasound examinations if they present with vaginal bleeding, symptoms of an ectopic pregnancy, and any other pregnancy related. Bochdalek hernia, the most common congenital diaphragm hernia in 95% of cases, is followed by morgagni hernia and esophageal hernia 5. Pdf posterolateral bochdalek diaphragmatic hernia in adults. Read this lesson to learn more about this specific type of hernia, common characteristics of the condition, and how to treat it. Bochdalek hernia is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the developing lung parenchyma and sometimes causing lung hypoplasia. Learning radiology morgagni, bochdalek, hernia, diaphragmatic.
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