Page 385 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-030
Value of Barium Meal Procedure in Diagnosing Late-Presenting Congenital
Diaphragmatic Hernia in a Child With Chronic Recurrent Vomiting:
A Case Report

Tiara Nien Paramita , Resita Sehati , Evita Karianni Bermanshah 2
2
1
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Most of the time, Congenital diaphragmatic hernia (CDH) is detected antenatally via fetal
ultrasound, but it may present late (child older than 1 month) in 5-25% cases. Patients with late-presenting
CDH often present to the emergency room with chest infections or GI symptoms, thus are prone to delayed
diagnosis and treatment. Barium meal procedure is a diagnostic tool commonly used to evaluate anatomical
malformations in children with GI complaints, but can be used to diagnose late-presenting CDH as patients
often come with GI symptoms. Objective To demonstrate late-presenting CDH case successfully diagnosed
by barium meal procedure. Case A 7-month-old boy was presented to the Gastroenterohepatology Clinic with
recurrent vomiting since 2 months old. Vomiting especially occurred one to two hours after drinking milk
enterally via nasogastric tube. He was clinically diagnosed as having gastroesophageal reflux disease and
given Omeprazole. Vomiting decreased but still persisted. When he was 6 months old, vomiting happened
more frequently as the milk volume was increased. Patient was evaluated for other differential diagnosis as
well as the possibility of congenital malformation. His abdominal ultrasound was within normal limit. Barium
meal examination showed some parts of intestines were inside the anterior thoracic area and the diaphragm
border was not evidently clear. This result suggested of Morgagni (anterior type) diaphragmatic hernia.
Thoracic ultrasound results further suggested apparent bowel loops and peristaltic bowel movements in the
chest. He was consulted to Pediatric Surgery department for surgical intervention. Conclusion Barium meal
procedure can be used as one of the diagnostic modalities in pediatric patients with suspected late-presenting
CDH cases. Differential diagnosis of CDH should be kept in mind in pediatric patients with chronic recurrent
vomiting with poor response to medication.
Keywords: congenital diaphragmatic hernia; barium meal; chronic recurrent vomiting

P-PI-031
The Role of Head Ultrasound for Detecting Periventricular Leukomalacia

Ulfa Putri Azizah , Naela Fadhila , H. F. Wulandari , Evita Karianni Bermanshah 2
2
1
2
1
2
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Periventricular leukomalacia (PVL) is the commonest brain injury in infant with the incidences
of 19.8%–34.1% for overall PVL and 2.5-23% for cystic PVL. It can be detected by head ultrasonography
(HUS). Neonates with PVL will have different outcome, 20% death, 25% will develop neurological problem
such as cerebral palsy. Early detection is very important to perform early intervention to prevent death or
severe neurological problem. Objective To demonstrate the sonograms of PVL with different grade of neonates
in perinatal ward of Ciptomangunkunsumo Hospital (RSCM). Cases Case 1: A male, small for gestational
age (SGA) infant (31 weeks, 1070 grams), was born with hyalin membrane disease (HMD) grade 1. HUS
screening was performed at age 1 weeks and found hyperechoic white matter in right periventricle (PVL
grade 1). Case 2: A male, SGA infant (31 weeks, 1400 grams), was referred to RSCM at 2 weeks old due
to NEC grade 3. HUS screening was performed at age 3 weeks and found periventricular cysts bilateral
(PVL grade 2) and right ventriculomegaly. Case 3: A male, SGA infant (29 weeks, 1200 grams), was born
with HMD grade 3. HUS screening was performed at age 2 and 3 weeks and the last finding was cysts
formation in periventricular and frontotemporal (PVL grade 3), intraventricular hemorrhage bilateral, and
ventriculomegaly. Conclusion Head ultrasound screening should be done routinely in infant with risk factors.
Keywords: periventricular leukomalacia (PVL); head ultrasound (HUS)

KONIKA XVIII Abstract Book 337