A neonate presents with respiratory distress, contralateral mediastinal shift and multiple cystic air filled lesions in the chest. Most likely diagnosis is?
C i.e. Congenital diaphragmatic hernia It is very easy to understand that intestinal coils migrating from abdomen (making it scaphoid) to chest, causing mediastinum to shift contralateraly. The swallowed air in the loops, is cause of multiple cystic air filled lesions in chest. So diagnosis is congenital diaphragmatic hernia. Bronchogenic cyst usually presents with minimal symptomps & no mediastinal shift. Differential diagnosis of Cystic appearing intrathoracic mass in new born are: 1. Congenital diaphragmatic herniaQ 2. Congenital lobar emphysema 3. Pneumatocoel formation 4. Broncho pulmonary malformations Bronchogenic cyst (Lung cyst)mcQ Cong. Cystic adenomatoid malformation - Broncho Pulmonary sequestration Multicystic Air filled Chest Lesion Contralateral Mediastinal shift & Respiratory distress No Mediastinal Shift 1. Congenital Diaphragmatic HerniaQ * Commonest(' 70% are left sidedQ Scaphoid abdomenQ due to migration of abdominal contents Malrotation & Malfixation of small bowel are associated problems Respiratory distress is most severe due to associated pulmonary hypoplasia, surfactant deficiency & persistent fetal circulation Immediate postnatal X Ray shows radiopaque hemithorax with C/L mediastinal shift. Once G.I. tract stas to fill with air radioluciencies appear & there will be progressive detion of mediastinum. Congenital Lobar Emphysema It is due to abnormal bronchial cailage 1/t obstruction of bronchus by ball-valve mechanism causing overinflation of affected lobe & compression of remaning lobes & C/L mediastinal shift. Left Upper lobe (40%>) Rt middle lobe(30%>) Rt upper lobe (20%) whole lung is not involved usuallyQ) involvement Male: Female = 3:1 Frequently associated with VSD, TOF, PDA Respiratory distress is progressive Immediately afer bih on CXR affected lobe is radiopaque which with in few days become hyperlucent d/t clearance of lung fluid, & over in flation of affected lobe CCAM (Cong. Systic Adenomatiod Malformation) Rare It is multicystic mass of pulmonary tissue; consisting of haraomatous proliferation of terminal bronchioles at expense of alveolar development; usually communicating with normal tracheobroncheal tree & receiving blood supply from narmal pulmonary aery & vein0. (difference from bronchopulmonary sequestration)Q Slight predilection for upper lobe (whole lung is rarely involved) Associated with Hydrops fetalis, maternal polyhydramnios, & other congenital malformation. . X Ray just after bih show -C/L mediastinal shift by radiopaque soft tissue mass. With progression fluid is absorbed and radiolucent areas representing air appear. 1. Bronchogenic (lung) cyst * Mediastinal type is more common than intrapulmonary * Carina! - mediastinal variety is most common * Usually do not communicate with tracheobroncheal tree * Usually presents with symptoms of infection 2. Broncho Pulmonary Sequestration(' * Mass of aberrant non functioning pulmonary tissue that does not communicate with normal bronchial tree or pulmonary ? aeries(' * Receives its blood supply from systemic circulation(' * Presents usually with recurrent infection & asymptomatic pulmonary mass at older age 3. PneumatoceleformationQ * Feature of childhood pneumonia mostly d/t staph. aureusQ * May be seen in Pneumocystis carinii Pneumonia (in AIDS)Q * Uncommon in neonates but may be seen with E. Coli & H. influenzea ; less common with staph aureus.
Pneumonia
Congenital Lung Cyst
Congenital diaphragmatic hernia
Congenital lobar Emphysema