Hepatic pulmonary fusion in an infant with a right-sided congenital diaphragmatic hernia and contralateral mediastinal shift.
Hepatic pulmonary fusion is extremely rare with only 9 previous cases reported in the literature. In typical cases, the clinician should be alerted to the possibility of hepatic pulmonary fusion if the chest radiograph shows a large opacity on the right side without a contralateral mediastinal shift. The authors present a case of right-sided diaphragmatic hernia and hepatic pulmonary fusion with associated contralateral mediastinal shift discovered beyond the neonatal period. The 9 previous cases were retrospectively reviewed with special attention to mediastinal shift on preoperative chest radiograph, operative procedure, and mortality. Only one previous case demonstrated a contralateral mediastinal shift. The most common procedure performed was partial separation of the hepatic pulmonary fusion and approximation of the diaphragmatic defect. Four of the previous 9 patients died. In our case, reduction of bowel and approximation of the diaphragmatic defect around the fused liver and lung have been successful.
Gander
Jeffrey W
JW
Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY 10032, USA.
Kadenhe-Chiweshe
Angela
A
Fisher
Jason C
JC
Lampl
Brooke S
BS
Berdon
Walter E
WE
Stolar
Charles J
CJ
Zitsman
Jeffrey L
JL
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000601:surgery*; D007839:Functional Laterality; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008099:Liver / Q000002:abnormalities* / Q000601:surgery*; D008168:Lung / Q000002:abnormalities* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D013902:Radiography, Thoracic; D019651:Plastic Surgery Procedures / Q000379:methods; D013526:Surgical Mesh; D013906:Thoracoscopy / Q000379:methods