24 Mar

Haziness of the Right Hemithorax in a Newborn

Haziness of the Right Hemithorax in a NewbornAccessory diaphragm is a rare congenital pulmonary anomaly that may be detected as an isolated roentgeno-graphic finding in asymptomatic individuals or it may present in association with major cardiopulmonary malformations. Usually occurring on the right, the accessory diaphragm is composed of connective and muscular tissue. It arises from the anterior diaphragm and extends cephalad and dorsally to insert on the posterior chest wall. Roentgenographic identification of the accessory diaphragm requires a lateral chest roentgenogram. We present a case of accessory diaphragm occurring in a neonate with transient respiratory distress. The initial chest roentgenograms did not include a lateral view, leading to diagnostic confusion regarding diffuse haziness over the right hemithorax. read only

Case Report
An 11-day-old boy was referred to the Louisiana Pediatric Pulmonary Center (LPPC) for evaluation of persistent haziness in the right hemithorax. He had been delivered by caesarean section because of marginal placenta previa and breech presentation. His trachea was intubated in the delivery room because of mild respiratory distress. His condition quickly improved and he was extubated shortly after transport to a nearby Neonatal Intensive Care Unit (NICU). Supplemental oxygen was discontinued within 48 hours.
Upon admission to the NICU, physical examination revealed a slightly increased respiratory rate with normal breath sounds. Results of the cardiac examination were normal. Initial anteroposterior (AP) chest roentgenogram showed a diffuse haziness over the right hemithorax which did not change during the hospitalization. The child was discharged in good condition on the sixth day of life.
At the LPPC, physical examination showed no abnormality except for slightly decreased breath sounds over the right upper lobe. The AP chest roentgenogram was unchanged from those during his hospitalization (Fig 1, left). A lateral chest film (Fig 1, right) was obtained for the first time.

Figure 1. AP chest roentgenogram (left) shows a diffuse haziness over the right hemithorax and a slight shift of the mediastinum to the right. The lateral chest roentgenogram (right) shows an anterior homogeneous density with a sharply defined border.

Figure 1. AP chest roentgenogram (left) shows a diffuse haziness over the right hemithorax and a slight shift of the mediastinum to the right. The lateral chest roentgenogram (right) shows an anterior homogeneous density with a sharply defined border.

Categories: Newborn
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