Congenital Diaphragmatic Eventration (Differential Diagnosis Repiratory Distress Syndrome)

Operative findings in a 1-day-old newborn with respiratory distress syndrome. The flaccid and thin diaphragm is held by two forceps to form a fold for duplication. The diagnosis is congenital diaphragmatic eventration which is a congenital hypoplasia of the diaphragm. The high position of the thin diaphragm leads to respiratory distress syndrome in neonates, or to less severe signs of the respiratory system in older children. The cause is a compression and insufficient ventilation of the ipsilateral lung with repeated infections. On x-ray there is a high position of the diaphragm like in figure atno_15_n.jpg; because it is not a phrenic nerve paralysis, fluoroscopy does not show the same paradoxical movements of the diaphragm. With a duplication of the diaphragm a normal position can be obtained, and less extensive excursions during respiration. The operation is the same as in phrenic nerve paralysis; the duplication consists of plication of the diaphragm and seaming up the diaphragmatic fold with avoidance of injury to the phrenic nerve.