每日一题_2023.03.07

A premature child is born in respiratory distress and is emergently intubated. Synthetic pulmonary surfactant is administered with no improvement in pulmonary function. After conducting a detailed physical examination, the pediatrician believes that this child’s condition is related to a failure of the embryonic pleuroperitoneal folds to form and close. What physical examination finding would support the most likely diagnosis in this child?

早产儿因呼吸窘迫而出生，需要紧急插管。使用合成肺表面活性物质对肺功能无改善。经过详细的体格检查，儿科医生认为该患儿的情况与胚胎期胸膜腹膜皱襞无法形成和闭合有关。哪些体格检查结果支持该患儿最有可能的诊断?

(A) Bowel sounds in the left lower lung zone 左下肺区肠鸣音

(B) Continuous cardiac murmur 持续心脏杂音

(C) Marked splenomegaly 脾明显肿大

(D) Midline deviation of the trachea 气管中线偏移

答案解析：

这个孩子患有先天性膈疝，是由于膈肌不能形成和闭合引起的。在肺区出现肠鸣音，表明腹腔内容物已疝出隔膜边界进入胸腔。发育中的膈肌是由食管横隔、胸膜腹膜皱襞、体壁和背侧系膜组成。这四个组成部分可以通过记忆法“几个部分组成隔膜”来记住。

正确答案：A