Prenatal Anatomical Imaging in Fetuses with Congenital Diaphragmatic Hernia

Claus, Filip; Sandaite, Inga; DeKoninck, Philip; Moreno, Óscar; Martínez, Rogelio Cruz; Mieghem, Tim Van; Gucciardo, Léonardo; Richter, Jute; Michielsen, Koen; Decraene, Jonas; Devlieger, Roland; Gratacós, Eduard; Deprest, Jan

doi:10.1159/000320605

Cited by 60 publications

(54 citation statements)

References 104 publications

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“…Doppler studies of the umbilical vein and hepatic vessels or location of the gall bladder may be used as additional landmarks. MRI is useful to confirm the diagnosis of CDH in cases of equivocal sonographic findings, to characterise the content of the herniated tissues [21]. Diaphragmatic eventration, characterised by defective diaphragmatic muscularisation, can be challenging to differentiate from CDH antenatally.…”

Section: Imaging Modalities For Cdhmentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

141

122

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Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

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Section: Imaging Modalities For Cdhmentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

141

122

View full text Add to dashboard Cite

show abstract

“…MRI fetal lung volume ratio has shown to be the more accurate method of prediction of survival in cases of left 29 and right CDH 30 . Observed/expected total lung volume as detected by MRI has shown to be a better independent predictor of postnatal survival to discharge in comparison with 2D ultrasound 27 …”

Section: Pathogenesismentioning

confidence: 99%

A review of congenital diaphragmatic hernia

Marlow

Thomas

2013

Australas J Ultrason Med

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Background: Congenital diaphragmatic hernia (CDH) is a simple diaphragmatic defect that is seen frequently in antenatal scans. Though the surgical repair is relatively easy in the neonate, the mortality is high due to pulmonary hypoplasia and pulmonary vascular changes. Materials and Methods: The goals of prenatal imaging are to establish the diagnosis. Assessment in a tertiary scanning center would identify prognostic factors which assist in counselling and planning antenatal management. However, the pulmonary hypoplasia associated with the CDH in moderate and severe cases makes the prognosis poor. Conclusions: Fetal intervention such as, fetal tracheal occlusion, is being trialled and may change the outcomes in the future.

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“…The diagnosis of CDH is usually suspected when the stomach is not observed in the normal intra-abdominal location. Diagnosis is identified by detecting direct signs of an intrathoracic mass containing the liver, bowel or stomach or by indirect evidence such as abnormal cardiac axis, mediastinal shift, scaphoid abdomen or polyhydramnios (20).…”

Section: Prenatal Diagnosismentioning

confidence: 99%