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• W4387247932 abstract "SESSION TITLE: Pediatrics Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Horses, not Zebras is a common phrase uttered in medical schools, clinics, and hospitals alike. It is meant to emphasize the importance of focusing one's diagnostics on ruling in/out the more common conditions associated with a given symptomology without immediately jumping to the more abstract. That said, it should be noted that rote repetition of such a phrase may introduce a level of subconscious bias in which one strictly excludes the Zebras because of their rarity and thereby misses a diagnosis. CASE PRESENTATION: A 9-month-old Caucasian male, ex-36 week, with a history of Trisomy 21, cardiac abnormalities, pulmonary hypertension, and tracheomalacia presented with hypoxia. He spent 2 months in the NICU with 6 subsequent hospitalizations for respiratory insufficiency/failure with infections as well as feeding intolerance. Ultimately patient discharged on oxygen for hypoxic episodes. Recent admission due to hypoxia in the setting of viruses treated with bronchiolitis protocol. Pulmonology was consulted, at this time a 2 view CXR was recommended, which identified a Morgagni hernia. On chart review, it was noted that lateral film had never been obtained. Despite a myriad of AP CXRs, cardiac shadow posed a challenge in diagnosing the hernia and it was therefore missed from time of birth. DISCUSSION: It is estimated that approximately 1 in 3,600 infants in the United States are born with a congenital diaphragmatic hernia (CDH). There are multiple kinds of diaphragmatic hernias based on the location of the bowel entry through the diaphragm. Morgagni hernias occur retrosternal and are the rarest type of CHD, accounting for approximately 1.5-3% of all CHDs. They are often associated with other congenital anomalies, most commonly cardiac defects and trisomy 21, as was the case with this patient. Because they are extremely rare and may present with vague gastrointestinal and/or respiratory symptoms, oftentimes they will not be identified until later in life or even post-mortem. CONCLUSIONS: This case report highlights the dangers of anchoring bias. Medical complexity that could explain respiratory distress distracts from the true diagnosis, which eluded multiple diagnosticians. This is an important reminder when examining a patient to look at the whole patient as an individual when assessing a symptom as broad as respiratory insufficiency. Although evidence-based medicine provides an excellent structure for diagnosing the masses, it is pivotal to take a step backward to look at the individual. REFERENCE #1: Svetanoff WJ, Rentea RM. Morgagni Hernia. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. REFERENCE #2: Gleeson F, Spitz L. Pitfalls in the diagnosis of congenital diaphragmatic hernia. Arch Dis Child. 1991 Jun;66(6):670-1. doi: 10.1136/adc.66.6.670. PMID: 2053783; PMCID: PMC1793171. REFERENCE #3: Chandrasekharan PK, Rawat M, Madappa R, Rothstein DH, Lakshminrusimha S. Congenital Diaphragmatic hernia - a review. Matern Health Neonatol Perinatol. 2017 Mar 11;3:6. doi: 10.1186/s40748-017-0045-1. PMID: 28331629; PMCID: PMC5356475. DISCLOSURES: No disclosure on file for Jeffrey Benson No relevant relationships by Rustin Cashel No disclosure on file for Holleigh McMasters No relevant relationships by Barbara Stewart" @default.
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• W4387247932 title "ALL THAT WHEEZES IS NOT ASTHMA OR BRONCHIOLITIS" @default.
• W4387247932 doi "https://doi.org/10.1016/j.chest.2023.07.3369" @default.
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