Abstract
Right congenital diaphragmatic hernia (RCDH) accounts for less than 10% of all diaphragmatic defects and is more difficult to detect than left CDH. Antenatal ultrasound provides the opportunity for in utero referral to a tertiary care centre for expert assessment and perinatal management. We present a case of isolated right CDH misdiagnosed during the second trimester ultrasound. A 28-year-old female primgravida, primipara had undergone regular prenatal care. Morphology ultrasound at 22 weeks showed no obvious structural anomalies. The fetal growth was appropriate throughout the pregnancy. A marked left-side deviation of the heart and compression of the right lung were noticed at 33 weeks of gestational ultrasound. To refine the diagnosis we performed a magnetic resonance imaging (MRI). An anterior right-sided diaphragmatic hernia was visualised. There was no herniation of intestines or stomach, but there was an important herniation of the liver into the right thoracic cavity. At a gestational age of 38 weeks a planned Caesarean section was performed and a boy weighing 2920 g was born. Respiratory distress occurred immediately after clamping of the umbilical cord. The new born was immediately intubated by the pediatrician and sent to the intensive care unit for further evaluation. Imaging studies after birth showed a right diaphragmatic hernia with severe pulmonary hypertension and poor lung function. A surgical intervention was planned but he died 24 hours after birth. The prenatal diagnosis of RCDH isn't always easy. The ultrasonography differentiation of the liver from the surrounding bowel and from lung tissue can be quite a challenge even with currently available high-frequency probes. Abnormal axis deviations can suggest an underlying CDH. The MRI can refine the diagnosis.
Published Version
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