Retrospective Comparison of Moderate and Severe Diaphragmatic Eventration in Children: Efficiency of Radiological Classification

Özet

Aim: Diaphragmatic eventration (DE) is a congenital or acquired elevation of the hemi-diaphragm. The indications for surgery may be challengingbecause clinical symptoms do not always correlate with radiological severity. We aim to identify the factors for the necessity and the efficiency ofthoracoscopic diaphragmatic plication (TDP) in children with DE.Materials and Methods: A retrospective cross-sectional analysis of patients treated for DE (April 2006-August 2017) was performed. Demographics,type of DE, laterality, associated malformations and clinical symptoms were evaluated. Patients were grouped in two groups (moderate and severe)according to their diaphragmatic elevation levels on X-ray at admission. The severe DE group (SDE, n=14) had a DE of more than 2 vertebral bodieswhereas the DE was 2 vertebral bodies or less in the moderate DE group (MDE, n=16). The groups were then compared regarding the necessity of TDP.The efficiency of TDP was analyzed by comparison of the outcome of patients who underwent TDP with that of conservative management.Results: There were 30 DE cases with a median age of 13.75 months. DE was acquired in 5 patients. The right side was the dominant side (21/30). Themost common clinical symptoms were pneumonia (21) and respiratory distress (7) while 6 cases were asymptomatic. Acquired DE and respiratorydistress were significantly higher in the SDE group. Four patients (25%) in the MDE group and 13 patients (92.9%) in the SDE group required TDP(p=0.000). The total number of cases of pneumonia was significantly higher in the conservatively treated patients in the follow-up (p=0.023).Conclusion: Two vertebral bodies may be an efficient cut-off level to discriminate between MDE and SDE. Absolute indications for TDP are SDE,acquired DE and respiratory distress at admission. Patients that are conservatively treated are more prone to pneumonia.