动态胸片评价小儿膈肌膨出：1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-01-01 DOI:10.1016/j.epsc.2024.102932

Takatoshi Abe , Kozo Nomura , Seisho Sakai , Rie Tanaka , Shuhei Minami , Hidenori Iwasaki , Yasuhiro Ikawa

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引用次数: 0

摘要

使用动态胸片（DCR）诊断膈肌疾病，这是一种新的成像检测方式，以前曾在成人中报道过；然而，尚无关于其在儿科患者中使用的报道。在此，我们报告一个14岁女孩的新病例诊断为横膈膜脱位（DE）使用DCR与极低剂量的脉冲x射线。一名14岁女孩因漏斗胸症转介至我院接受手术治疗。术前胸片显示右膈高于左膈，但此差异在正常范围内。CT示Haller指数3.00。虽然病人没有任何症状，但她抱怨自己的外表令人不满意，这被认为是手术的指征。Nuss手术是在人工气胸下进行的，没有怀疑DE。术后6个月，我们用DCR代替胸片来评估棒的位置和患者的呼吸状态。利用捕获的图像，我们进一步测量和分析了隔膜的运动。DCR显示患侧膈肌运动明显受损，患者随后被诊断为DE。然而，由于她无症状，我们决定保守随访。结论首次报道小儿患者发生DCR。DCR似乎是一个有用的工具，诊断横膈膜外翻在儿童。

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Evaluation of pediatric diaphragmatic eventration using dynamic chest radiography: A case report

Introduction

Diagnosis of diaphragmatic disease using dynamic chest radiography (DCR), a novel imaging testing modality has been previously reported in adults; however, there have been no prior reports of its use in pediatric patients. Herein, we report the novel case of a 14-year-old girl diagnosed with diaphragmatic eventration (DE) using DCR with extremely low-dose pulsed X-rays.

Case series

A 14-year-old girl with pectus excavatum was referred to our hospital for surgery. Pre-operative chest radiography revealed that the right diaphragm was higher than the left however, this difference was judged to be within the normal range. Computed tomography (CT) revealed a Haller index of 3.00. Although the patient had no symptoms, she complained of an unsatisfactory appearance, which was considered an indication for surgery. The Nuss procedure was performed under artificial pneumothorax, and DE was not suspected. Six months after surgery, we performed DCR instead of chest radiographs to evaluate the position of the bar and the patient's respiratory status. Utilizing the captured images, we further measured and analyzed the diaphragm movement. DCR revealed a clear impairment of diaphragmic movement on the affected side, and the patient was subsequently diagnosed with DE. However, as she was asymptomatic, we decided to follow up conservatively.