Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Kareem Abdelhamid, OMS-III 2 ; Gowrish Vaka, OMS-III 2 ; Dr. Alpeesh Patel, MD 1 ; Hassan Khannani, OMS-III 2 ; Wasif Syed, OMS- III 2 ; Abir Islam, OMS-III 2 ; Roopin Singh, OMS-III 2 1 Department of General Surgery and Anesthesiology, Willis- Knighton Medical Center, Shreveport, LA; 2 VCOM-Louisiana 78 A CASE REPORT ON THE MANAGMENT OF CONGENITAL DIAPHRAGMATIC HERNIA WITH CARDIAC FINDINGS

Kayla Fraser, OMS-II 1 ; John Lipka, MD 2 ; Stephanie Aldret, DO, FAOASM 3 1 VCOM-Louisiana; 2 University of Louisiana Monroe 79 ATYPICAL THORACIC OUTLET SYNDROME IN A COLLEGIATE ATHLETE: DIAGNOSIS AND MANAGEMENT

Background: Congenital Diaphragmatic Hernia (CDH) is a rare disorder that occurs in approximately 1 in 3600 births. While the condition is not a surgical emergency, a surgical correction will prevent the development of a CDH into a life-threatening condition. Approximately 33% of infants with a CDH have concurrent structural abnormalities, the most common of which involve the cardiovascular system (14%). We present a case of a 1-day old male, born at 37 weeks, with tachypnea, nasal flaring, and grunting. The patient’s chest x-ray revealed a left CDH, which was confirmed by the visualization of an orogastric tube in the chest area. Subsequently, a preoperative echocardiogram was done and revealed a PDA and PFO. The patient was intubated and placed on conventional vent rate 30, 30/5 PIP/PEEP 50%, a Replogle tube placed and hooked to suction, and umbilical arterial and venous catheters placed. Once the patient was hemodynamically stable, surgical correction was initiated with fentanyl used as the primary anesthetic. The procedure was tolerated well, the baby was extubated after two days, and the fentanyl drip was discontinued. Patients with CDHs pose an anesthetic complication

as they have differences in cardiopulmonary physiology, such as pulmonary hypoplasia. Due to this, volatile anesthetics and Neuromuscular blocking agents (NMBAs) are often avoided, and anesthesia is maintained via high doses of intravenous opioids. The anesthesiologist must recognize the importance of a non traditional approach when addressing neonatal patients with CDHs to avoid accidentally further compromising cardiopulmonary function. References: Keita, P., Han, F., Peterman, N. J., Toledo, S., & Munaco, A. (2022). Transcatheter Occlusion of a Patent Ductus Arteriosus for a Symptomatic Left-to-Right Shunt. Cureus, 14(5), e24733. https://doi.org/10.7759/cureus.24733 Leininger K, Chiu K. Anesthetic Considerations in Congenital Diaphragmatic Hernia. [Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK572077/ Quinney, M., & Wellesley, H. (2018). Anaesthetic management of patients with a congenital diaphragmatic hernia. BJA education, 18(4), 95–101. https://doi. org/10.1016/j.bjae.2018.01.001

Context/Impact: Vascular thoracic outlet syndrome (VTOS) is a condition characterized by neurovascular compression at the thoracic outlet, which can significantly impact athletes’ performance and overall health. This case report presents the clinical case of a collegiate softball player diagnosed with VTOS, emphasizing the impact of repetitive upper extremity movements common in sports. Report of Case: An 18-year-old college softball middle infielder presented for her initial preparticipation physical examination with a two-year history of right shoulder pain with associated radicular symptoms. She was initially diagnosed with shoulder instability then biceps tendinitis and then pectoralis minor syndrome, prompting a series of ultrasound-guided corticosteroid injections, Botox injections, and physical therapy with minimal relief and evolution of symptoms. X-rays and MRI Arthrogram revealed no abnormalities. EMG/NCS results were also unremarkable. Her preparticipation physical exam was unremarkable except for pain in her right shoulder with left cervical rotation and a positive Adson’s maneuver on the right, which resulted in a complete

disappearance of her right radial arterial pulse. Considering she had failed previous conservative treatment measures; she elected to undergo a surgical evaluation by a vascular surgeon. Vascular ultrasound of her right upper extremity (RUE) with velocity measurements revealed no evidence of arterial stenosis or occlusion, triphasic flow throughout the RUE, and antegrade flow in the right vertebral artery at rest; with dynamic testing by performing military maneuvers, her measurements were significantly elevated confirming a right Thoracic Outlet Syndrome. Two weeks following her sports physical, she underwent a right first rib resection, right thoracic outlet decompression, brachial plexus neurolysis, phrenic nerve neurolysis, and exploration of the right subclavian artery. She experienced almost immediate relief of her symptoms, except for slight forearm numbness. Comments/Conclusion: Thoracic outlet syndrome (TOS) is typically a condition found in pitchers or overhead athletes, which is why this case is so unique. Since the athlete is a middle infielder and not the typical TOS candidate, therapy was started and progressed with careful

consideration. She was allowed to start light ball tossing at 8-10 weeks post-surgery and is currently working on a hitting protocol, created by her athletic trainer. The protocol was initiated at the 12-week mark to ease her into the motion of batting. Once the protocol is finished at week 19, she will begin live practice and return to full sport without restrictions. When softball season begins, she should be ready for full competition.

92

93

2025 Research Recognition Day