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Liver Herniation Presenting as Respiratory Distress and Cardiomegaly

PHILIP J. HOFSCHIRE, MD; WILLIAM F. FLEMING, MD; JOSEPH R. ELLISON, MD; PEGGY Jo RAPOPORT, MD
Am J Dis Child. 1980;134(11):1091-1092. doi:10.1001/archpedi.1980.02130230069020.
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Respiratory distress and cardiomegaly in the immediate postnatal period are most frequently due to primary disease of the lungs or the vascular system. Herniation of the liver through the diaphragm into the chest cavity is rare, but can cause respiratory embarrassment and cyanosis.1 Hypoplastic left heart syndrome, coarctation of the aorta, and Ebstein's anomaly of the tricuspid valve all may manifest cardiomegaly and respiratory distress.2 Sepsis,3 hypocalcemia,4 and asphyxia5 have also produced such findings. The following case report is one of congenital liver herniation manifesting respiratory distress and generalized cardiomegaly. Previously reported cases of liver herniation have not mentioned cardiomegaly as an early finding.

Report of a Case.—A 6-hour-old boy was admitted because of progressive tachypnea and cyanosis beginning one hour after birth. Vaginal delivery was uneventful, with Apgar scores of 8 and 9 at one and five minutes, respectively. Birth weight was 3,843.8

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