Scaphoid Abdomen

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Infant Respiratory Distress Syndrome

Figure 1.67. Radiograph of another infant with congenital cystic adenomatoid malformation of the lung on the left side. This infant developed increasingly severe respiratory distress within 18 hours of birth as a result of progressive air trapping and hyperinflation. In these infants, surgical removal of the malformation is essential.

Congenital cystic adenomatoid malformation may present initially as an intrapulmonary mass which appears solid or has a few scattered translucent areas, but this progresses to give the typical appearance of congenital cystic adenomatoid malformation.

Figure 1.67. Radiograph of another infant with congenital cystic adenomatoid malformation of the lung on the left side. This infant developed increasingly severe respiratory distress within 18 hours of birth as a result of progressive air trapping and hyperinflation. In these infants, surgical removal of the malformation is essential.

Congenital cystic adenomatoid malformation may present initially as an intrapulmonary mass which appears solid or has a few scattered translucent areas, but this progresses to give the typical appearance of congenital cystic adenomatoid malformation.

Figure 1.68. This chest radiograph shows pulmonary agenesis on the left side. Note the hyperinflated right lung with widening of the intercostal spaces and splaying of the ribs. The heart is displaced to the left side. In pulmonary agenesis the affected hemithorax is opaque, and the mediastinal structures occupy the airless space. Total agenesis of both lungs is very rare. Absence of the left lung is more frequent than of the right lung. The remaining lung is larger than normal and often herniates into the contralateral chest. Soon after a groove develops in the laryngotracheal tube, the tracheal portion bifurcates into the right and left lung bronchi. Failure to do so may result in agenesis. The presence of another anomaly, such as a vertebral defect, strongly supports the diagnosis of agenesis.

Figure 1.69. This infant had minimal respiratory distress, but on physical examination was noted to have asymmetry of the chest. A chest radiograph showed a marked difference in the width of the intercostal spaces between the left and right side of the chest. The right lung is opacified and the right hemithorax is small; the left lung is hyperexpanded. Hypogenetic lung syndrome (alveolar hypoplasia) is a variant of pulmonary agenesis. Congenital heart disease is apparently more common with right than with left lung hypogenesis. In this infant there was dextrocardia, pulmonary artery hypopla-sia, and anomalous systemic arterial supply to the right lower lobe with anomalous venous drainage.

Figure 1.70. This infant with a scaphoid abdomen and barrelling of the chest had a diaphragmatic hernia. In any infant with a scaphoid abdomen, two surgical emergencies should be excluded - congenital diaphragmatic hernia, and esophageal atresia with a blind pouch and no communication with the gastrointestinal tract. Normally, the passage of air into the gastrointestinal tract after birth distends the scaphoid abdomen. In severe neuromuscular disease or central nervous system depression, air is not swallowed, hence the abdomen also remains scaphoid.

Scaphoid Abdomen Causes

Figure 1.71. A radiograph of an infant with a Bochdalek-type congenital diaphragmatic hernia shows a midline abdominal stomach and multiple fluid and air-filled loops of bowel in the left hemithorax. Left-sided herniae occur five times more frequently than right-sided herniae. The incidence of this defect is 1:4000 live births and it constitutes a neonatal emergency if there is severe respiratory distress in the first hour of life. The infant swallows air which inflates the stomach and small bowel, causing collapse of the lung and displacement of the mediastinum. In severe cases, the stomach, small bowel, and left lobe of the liver may lie in the hemithorax during fetal life, resulting in hypoplasia of the lungs.

Scaphoid Abdomen Diaphragmatic Hernia

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Abdomen Disorders

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Figure 1.72. Anteroposterior and lateral radiographs of an infant with a diaphragmatic hernia who presented with severe respiratory distress at birth. Note the displacement of the heart to the right and the lack of gas in the gastrointestinal tract. In the lateral view, note the scaphoid appearance of the abdomen.

Figure 1.72. Anteroposterior and lateral radiographs of an infant with a diaphragmatic hernia who presented with severe respiratory distress at birth. Note the displacement of the heart to the right and the lack of gas in the gastrointestinal tract. In the lateral view, note the scaphoid appearance of the abdomen.

Scaphoid Abdomen

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Scaphoid Abdomen Diaphragmatic

Figure 1.73. Infants with diaphragmatic herniae may present with a wide spectrum of symptoms. This infant had minimal respiratory distress, but some abdominal distention and vomiting. A contrast study of the colon demonstrates its location in the left hemi-thorax, confirming the diagnosis of a congenital diaphragmatic hernia.

Figure 1.73. Infants with diaphragmatic herniae may present with a wide spectrum of symptoms. This infant had minimal respiratory distress, but some abdominal distention and vomiting. A contrast study of the colon demonstrates its location in the left hemi-thorax, confirming the diagnosis of a congenital diaphragmatic hernia.

Right Sided Diaphragmatic Hernia

Figure 1.74. In this radiograph note a right-sided diaphragmatic hernia with the liver and bowel in the right side of the chest. Bochdalek-type herniae are typically large and involve a posterolateral defect in the foramen of Bochdalek. Morgagni herniae are retrosternal and involve the foramen of Morgagni. Ninety-eight percent of all defects are the Bochdalek type. Symptoms are generally less severe when the hernia is on the right side.

Figure 1.75. In this infant with a congenital diaphragmatic hernia, there was vigorous resuscitation at birth. Prolonged bag-mask ventilation can distend the stomach and intestine with air, thus increasing the respiratory distress. Note that the mediastinum and heart are shifted to the right even after decompression and that the markedly distended stomach is in the thoracic cavity. Gastric aspiration relieved the distention as noted in the radiograph on the right. Infants with congenital diaphragmatic hernia often require vigorous resuscitation; thus it is important to place an orogastric tube during resuscitation if diaphragmatic hernia is suspected.

Orogastric Tube

Figure 1.76. In this infant with Rh isoimmunization and a congenital diaphragmatic hernia, contrast was injected into the amniotic fluid of the fetus to permit swallowing of the contrast for confirmation of the position of the fetal bowel prior to intrauterine transfusion. At birth, the infant was noted to have respiratory distress, and a plain radiograph of the chest and abdomen showed the contrast-filled bowel lying in the chest, confirming the diagnosis of a diaphragmatic hernia. This is of historic interest only because this practice has been replaced by the use of ultrasound during the procedure of intrauterine transfusion.

Figure 1.77. The asymmetry of the chest in this infant is a result of eventration of the diaphragm. Note the elevation with ballooning of the chest on the right side. Eventration is a congenital thinning of the muscle of the pleuroperitoneal membrane portion of the diaphragm. Thinning allows upward displacement of the liver, thereby elevating the ribs on the affected side. It is usually unilateral, rarely bilateral. If respiratory distress is not severe, these infants may be treated conservatively.

Figure 1.78. An anteroposterior and lateral radiograph of die chest of an infant widi eventration of the diaphragm. Note die right diaphragm elevated well above die left with die increased density of die liver below it. Eventration of die diaphragm should be differentiated from paralysis of the diaphragm. On fluoroscopic examination, if die diagnosis is eventration of die diaphragm, there is movement of die diaphragm widi respiration whereas, if die diagnosis is paralysis of die diaphragm, diere is lack of movement. Currently, die diagnosis is made by ultrasonography.

Figure 1.76. In this infant with Rh isoimmunization and a congenital diaphragmatic hernia, contrast was injected into the amniotic fluid of the fetus to permit swallowing of the contrast for confirmation of the position of the fetal bowel prior to intrauterine transfusion. At birth, the infant was noted to have respiratory distress, and a plain radiograph of the chest and abdomen showed the contrast-filled bowel lying in the chest, confirming the diagnosis of a diaphragmatic hernia. This is of historic interest only because this practice has been replaced by the use of ultrasound during the procedure of intrauterine transfusion.

Metabolic Disorders

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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Responses

  • simret elias
    What is a scaphoid abdomen?
    6 years ago
  • sandra
    What is scaphoid hernia?
    5 years ago
  • charles
    What kind of defect in nervous system would occur with bochdalek hernia?
    4 years ago
  • olo
    Is scaphoid abdomen normal in a newborn?
    4 years ago
  • Doderic
    What is a scaphoid appearance?
    2 years ago
  • Elfstan
    Is scaphoud abdonen serious?
    5 days ago

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