Imaging of congenital diaphragmatic hernias

Abstract

Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients.

Congenital diaphragmatic hernia

“…Bowel gas may be seen in the chest. The oesophageal portion of the nasogastric tube is deviated to the right in infants with left-sided CDH and to the left if the lesion is on the right [39]. Introduction of a radioopaque contrast medium into the stomach and proximal gastrointestinal tract can help to distinguish between a CDH and a congenital thoracic malformation such as congenital cystic adenomatoid malformation.…”

Bilateral morgagni hernia in a case of Weill-Marchesani syndrome-a rare association

“…Hepatic echo-texture and color Doppler sonogram can confirm liver in thorax. 19 Hernias that contain hollow viscera can be more difficult to evaluate with US. Air in the bowels and lungs, as well as rib shadowing, can often distort the images and make them difficult to interpret.…”

Adverse effect left congenital diaphragmatic hernia to position and function of the fetal heart

“…Diagnosis hernia Bochdalek can be done during antenatal, based on the ultrasound picture of abdominal organs entering left thoracic cavity, there is stomach or others organs into the chest cavity, and the shifting lies the heart of its normal position caused by the pressure. 1,2,7 Location of the heart can be shifted to the right or insistence towards the front approaching the anterior thoracic wall.). 6,7 CDH suspicion can be enforced were no stomach appearance in the abdominal cavity, mediastinal shift, polyhydramnios happen to some severe cases (80% of cases Bochdalek hernia accompanied by polyhydramnios) and rarely there may be fetal hydrops.…”

“…6,7 CDH suspicion can be enforced were no stomach appearance in the abdominal cavity, mediastinal shift, polyhydramnios happen to some severe cases (80% of cases Bochdalek hernia accompanied by polyhydramnios) and rarely there may be fetal hydrops. 1,2 Typical findings are the presence of the stomach or loops of bowel within the thoracic cavity-ideally level with the 'four-chamber' view of the fetal heart, along with mediastinal shift away from the side of the lesion. The diagnosis can be missed if the stomach is not in the thorax, right-sided defects are also more difficult to diagnose.…”