64G / 147 Peculiarities in a Case with Recurrent Pneumonia

64G / 147 – PECULIARITIES IN A CASE WITH RECURRENT PNEUMONIA. SI Iurian, ML Neamtu, BM Neamtu, BI Mehedintu. Lucian Blaga University Pediatric Clinic - Sibiu (Romania)

Background. The hiatal hernia appears when a portion of the stomach prolapses through an opening in the diaphragm. Objectives. The authors emphasize the diagnosis difficulties in an infant with failure to thrive admitted for respiratory failure and gastro-intestinal tract symptoms. Methods. The 1st admittance (at the age of 6 months) was triggered by paroxistic cough and cyanosis. The clinical exam has revealed malnutrition and the laboratory investigations were normal. The 2 nd admittance (10 months old) was due to hematemesis, high fever and respiratory failure. The authors have considered basal right pneumonia based on chest X ray exam. The clinical evolution was good although the repeated X ray image was unchanged. At the age of 11 months the infant was admitted for hematemesis and clinical exam has revealed cachexia (-3 SD) and cyanosis. The inflammatory markers, sweat test and haemostasis function were normal. During the 3rd day, a paroxistic episode of vomits, cyanosis and cough was induced by feeding. Specific intestinal bruits were discovered on chest auscultation and the chest X ray image was quite similar as compare to previous ones. Interestingly, the authors did not reveal the stomach air bubble. Results. The clinical signs induced by feeding correlated with an abnormal chest X ray image have led to the contrast examination of gastrointestinal tract. A hiatal hernia due to a shortened esophagus has been found and the patient was transferred in the surgical clinic. Conclusions. This case was diagnosed incidentally after 2 life-threatening events in the context of malnutrition. The contrast examination of GI tract was mandatory for the diagnosis. None of the 3 previously chest X rays has revealed the bubble air in gastric fundus. This could be a precocious radiological sign for hiatal hernia diagnosis.