Imaging findings in fetal diaphragmatic abnormalities

Abstract

Imaging plays a key role in the detection of a diaphragmatic pathology in utero. US is the screening method, but MRI is increasingly performed. Congenital diaphragmatic hernia is by far the most often diagnosed diaphragmatic pathology, but unilateral or bilateral eventration or paralysis can also be identified. Extralobar pulmonary sequestration can be located in the diaphragm and, exceptionally, diaphragmatic tumors or secondary infiltration of the diaphragm from tumors originating from an adjacent organ have been observed in utero. Congenital abnormalities of the diaphragm impair normal lung development. Prenatal imaging provides a detailed anatomical evaluation of the fetus and allows volumetric lung measurements. The comparison of these data with those from normal fetuses at the same gestational age provides information about the severity of pulmonary hypoplasia and improves predictions about the fetus's outcome. This information can help doctors and families to make decisions about management during pregnancy and after birth. We describe a wide spectrum of congenital pathologies of the diaphragm and analyze their embryological basis. Moreover, we describe their prenatal imaging findings with emphasis on MR studies, discuss their differential diagnosis and evaluate the limits of imaging methods in predicting postnatal outcome.

Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach‐down left congenital diaphragmatic hernia

“…A bnormal position of the stomach adjacent to the fetal heart is a key diagnostic feature of left congenital diaphragmatic hernia (CDH). 1,2 This key feature is absent in stomach-down left CDH, when the stomach remains in the abdomen, with resultant increased difficulty in recognition of the anomaly (Figure 1). A recent publication by Aiello et al 3 described the abnormal position of the stomach in contact with the fetal bladder in the setting of stomach-down left CDH in six of nine cases.…”

Ultrasound, Echocardiography, MRI, and Genetic Analysis of a Fetus with Congenital Diaphragmatic Hernia and Partial 11q Trisomy

“…Left side CDHs are easier to be identified during ultrasound examination because they affect the stomach, small bowel, and colon. Extensive hernias are associated with cardiomediastinal shift and bilateral lung hypoplasia and consequently with a poor prognosis [4, 8]. Bilateral CDHs are very uncommon and they are associated with a fatal outcome.…”

“…A high percentage of CDH is identified during prenatal ultrasound, when the liver and/or the intestines are presented in the chest together with a malpositioned heart. CDH impairs normal lung development, which implies pulmonary hypoplasia determining the fetus outcome [4]. The size of CDH is important in order to assess the risk of neonatal morbidity and mortality.…”

“…Fetal echocardiography is essential since cardiac defects are the most common abnormality associated with CDH and it determines a possible early surgery [3]. Fetuses presenting with other malformations, chromosome abnormalities, and/or syndromes together with or including CDH show a lower survival rate than those with isolated CDH [4]. …”

Multimodality imaging of adult gastric emergencies: A pictorial review

“…Herniation of stomach is more common in Bochdalek hernia, whereas Morgagni hernia mainly contains part of the liver. [27] Morgagni hernia involves the herniation of intra-abdominal contents into the chest through a defect between the sternal and costal attachments of the diaphragm (space of Larrey) situated anteromedially. Bochdalek hernia occurs in the left posterolateral chest and is due to the malformation of pleuroperitoneal membranes.…”