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NBME 20 Answers

nbme20/Block 2/Question#11 (40.2 difficulty score)
A female newborn delivered at 36 weeks' ...
Incomplete formation of pleuroperitoneal membraneπŸ”,πŸ“Ί
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 +11 
submitted by monoloco(136),
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johnthurtjr  Usually on the left because the liver prevents herniation through the right hemidiaphragm +9  
asdfghjkl  aka congenital diaphragmatic hernia +3  
pg32  What's weird to me is that if you usually see air in the intestines on x-ray when they are in the abdomen, why is there no air in the thorax in CDH? The intestines should still have air in them, right? Also, what is filling the abdomen that causes it to appear grayed-out in CDH? +  
drzed  @pg32 You can actually see a gastric bubble if you squint hard enough. Look at where the NG tube is placed; there is a radiolucency to the patient's right of the NG tube which is most likely the stomach. It probably then is radioopaque distally due to the pyloric sphincter, and air having a tendency to rise. +2  
bbr  Any idea what "absence of bowel gas in the abdomen" is referring to? +  
rkdang  my interpretation was absence of bowel gas in abdomen --> the bowel is not in the abdomen --> incomplete formation of pleuroperitoneal membrane bowel gas is a normal finding that you often see on x rays of the abdomen in a normal patient +1  
seba0039  @rkdang is it also abnormal that you cannot see any air in the lungs? This threw me off when I was trying to read the radiograph. +