Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated...Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated diaphragmatic hernia which has not been documented previously. Case Presentation: We report a case of previously undiagnosed complete absence of a hemidiaphragm in a 62-year-old male who presented with recurrent respiratory infection, episodes of nausea and postprandial fullness. Computed Tomography scan showed a large cyst in relation to the lower lobe of left lung. During surgery, he was found to have complete absence of a left hemidiaphragm and a large cyst arising from the lower lobe of left lung occupied the common thoracoabdominal space. Abdominal viscera were found displaced downwards and fixed in a thick fibrous membrane. There was no herniation of abdominal organs into the thoracic cavity after excision of the cyst. The left lung could be fully expanded and chest was closed after putting a chest drain. Diaphragmatic agenesis did not require any additional procedure. The cyst was excised with closure of bronchocystic opening. The patient had an uneventful recovery. Conclusions: The association of lung cyst with diaphragmatic agenesis (presented in the adulthood) is rare. It has precluded a diaphragmatic hernia and survived the patient acting as a protective barrier. The significance of lung cyst in presence of diaphragmatic agenesis lies in the absence of associated diaphragmatic hernia which has not been documented previously.展开更多
Background: Aortico-right ventricular tunnel is an extremely rare congenital defect rarely described in an infant. This diagnosis is likely to be missed due to its rare entity and similar clinical presentations with o...Background: Aortico-right ventricular tunnel is an extremely rare congenital defect rarely described in an infant. This diagnosis is likely to be missed due to its rare entity and similar clinical presentations with other aortico-right ventricular communications like ruptured sinus of valsalva. Methods: We report a case of previously undiagnosed aortico-right ventricular tunnel along with a perimembraneous ventricular septal defect in an 18-year-old female. She had history of exertional dyspnoea, palpitation, history of recurrent lower respiratory tract infection. She was diagnosed as a case of ruptured sinus of valsalva (RSOV) elsewhere. She had “to and fro” murmur, features of congestive cardiac failure. Her echo diagnosis was RSOV. On surgical exploration, after opening the aorta, we found a tunnel like opening in the aorta leading to the roof of RV cavity in between right and non coronary sinuses at the commissural level. Cusps were splayed wide part. Ventricular septal defect was conspicuous from right atrial approach. Post operative CT angio was done. Results: Venricular septal defect was closed from the right atrial approach and aortico-right ventricular tunnel was repaired through aortic and right venricular approach. Postoperative CT angio also confirmed the location and closure of the defects. Postoperative recovery was uneventful. Conclusions: Aortico-right ventricular tunnel in an adult female has not been reported in the literature previously. This rare entity should be considered in the differential diagnosis of a critically ill patient with a “to and fro” murmur, and signs of right heart failure.展开更多
文摘Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated diaphragmatic hernia which has not been documented previously. Case Presentation: We report a case of previously undiagnosed complete absence of a hemidiaphragm in a 62-year-old male who presented with recurrent respiratory infection, episodes of nausea and postprandial fullness. Computed Tomography scan showed a large cyst in relation to the lower lobe of left lung. During surgery, he was found to have complete absence of a left hemidiaphragm and a large cyst arising from the lower lobe of left lung occupied the common thoracoabdominal space. Abdominal viscera were found displaced downwards and fixed in a thick fibrous membrane. There was no herniation of abdominal organs into the thoracic cavity after excision of the cyst. The left lung could be fully expanded and chest was closed after putting a chest drain. Diaphragmatic agenesis did not require any additional procedure. The cyst was excised with closure of bronchocystic opening. The patient had an uneventful recovery. Conclusions: The association of lung cyst with diaphragmatic agenesis (presented in the adulthood) is rare. It has precluded a diaphragmatic hernia and survived the patient acting as a protective barrier. The significance of lung cyst in presence of diaphragmatic agenesis lies in the absence of associated diaphragmatic hernia which has not been documented previously.
文摘Background: Aortico-right ventricular tunnel is an extremely rare congenital defect rarely described in an infant. This diagnosis is likely to be missed due to its rare entity and similar clinical presentations with other aortico-right ventricular communications like ruptured sinus of valsalva. Methods: We report a case of previously undiagnosed aortico-right ventricular tunnel along with a perimembraneous ventricular septal defect in an 18-year-old female. She had history of exertional dyspnoea, palpitation, history of recurrent lower respiratory tract infection. She was diagnosed as a case of ruptured sinus of valsalva (RSOV) elsewhere. She had “to and fro” murmur, features of congestive cardiac failure. Her echo diagnosis was RSOV. On surgical exploration, after opening the aorta, we found a tunnel like opening in the aorta leading to the roof of RV cavity in between right and non coronary sinuses at the commissural level. Cusps were splayed wide part. Ventricular septal defect was conspicuous from right atrial approach. Post operative CT angio was done. Results: Venricular septal defect was closed from the right atrial approach and aortico-right ventricular tunnel was repaired through aortic and right venricular approach. Postoperative CT angio also confirmed the location and closure of the defects. Postoperative recovery was uneventful. Conclusions: Aortico-right ventricular tunnel in an adult female has not been reported in the literature previously. This rare entity should be considered in the differential diagnosis of a critically ill patient with a “to and fro” murmur, and signs of right heart failure.
