Common Congenital Diaphragmatic Hernia Research Articles

Fetal magnetic resonance imaging in the evaluation of congenital diaphragmatic anomalies

BackgroundCongenital abnormalities of the diaphragm cause impairment of lung development and are an important cause of post-natal morbidity and mortality. Congenital diaphragmatic eventration (CDE), a less sinister diaphragmatic anomaly compared to the more common congenital diaphragmatic hernia (CDH), often tends to mimic CDH on prenatal imaging. This study evaluates the role of fetal magnetic resonance imaging (MRI) in differentiating these two entities.ResultsThis was a retrospective study which included fetal MRI studies done in patients with ultrasound diagnosis of fetal diaphragmatic anomaly. MRI exam was performed with a 1.5 T superconducting system with eight-element torso array coil. The images were studied by two radiologists experienced in fetal imaging in consensus. Diagnosis of CDE was made if the dome of the diaphragm was visualized as a thin hypointense line separating the lung from abdominal structures on coronal and sagittal MRI sequences. If this thin hypointense line was not visualized, a diagnosis of CDH was made. The findings were then correlated with autopsy/intra-operative findings/post-natal imaging follow-up. A total of 12 patients were included in the study. In these 12 patients, 13 diaphragmatic abnormalities were diagnosed on MRI (1 fetus had bilateral diaphragmatic anomaly). Of the 13 diaphragmatic anomalies detected, 7 (54%) were CDH and 6 (46%) were CDE. The type of diaphragmatic anomaly was correctly identified on MRI in all except one fetus in which CDE was misdiagnosed as CDH. The Fisher exact test statistic value was 0.0047. The result was significant at p < 0.01.ConclusionFetal MRI is a useful tool for assessing congenital diaphragmatic anomalies. Visualization of the diaphragm on coronal and sagittal images helps in diagnosis of complete CDE and differentiating it from the more sinister CDH.

Right Sided Bochdalek Hernia in Adult: A Case Report &amp; Review of Literature

Bochdalek hernia is the most common congenital diaphragmatic hernia that typically presents in childhood. However, right sided diaphragmatic hernia is relatively rare. We review the case of 21 years old female with incidentally detected congenital diaphragmatic hernia on the right side. There are fewer than 20 cases of right sided diaphragmatic hernia reported in adults in literature.

Incarcerated right-sided diaphragmatic hernia in a patient undergoing Roux-en-Y gastric bypass

Bochdalek hernia is the most common congenital diaphragmatic hernia. Its symptoms are normally diagnosed and treated during the neonatal period. Conversely, in adults it is usually asymptomatic and, as a consequence, this group is misdiagnosed. A case of a 64-year-old female patient with an uncommon incarcerated right-sided diaphragmatic hernia formed three years after a Roux-en-Y gastric bypass and a significant weight loss is reported. The importance of this abnormality as a complication of the bariatric surgery should be considered. Key words: Diaphragmatic hernia; gastric bypass; bariatric surgery.

Neonatal Intrathoracic Stomach without Gastric Volvulus.

Intrathoracic stomach is a rare and serious congenital abnormality. The anomaly may be complicated by gastric volvulus and can lead to ischemic gastric infarction in the neonate. If diagnosed antenatally, neonatal management can be planned in advance so as to reduce morbidity. This anomaly must be differentiated from the more common congenital diaphragmatic hernia, as associated pulmonary hypoplasia is common in the latter and rare with gastric herniation. We report a case of intrathoracic stomach in a neonate without volvulus, fortunately a rare entity which was managed operatively, and the child has been under regular follow-up.

Congenital paraesophageal hernia: The Montreal experience

IntroductionCongenital paraesophageal hernia (CPEH) is the least common congenital diaphragmatic hernia. We performed an extensive review to further define this entity. MethodsA retrospective study of children with CPEH (types II–IV hiatal hernias) treated at two children’s hospitals over a 25-year period (1988–2013) was performed. ResultsFourteen patients were diagnosed at a median age of 35days (range 0–500), with one prenatal diagnosis. The most common symptoms were emesis in type II hernias (50%), and respiratory distress in types III and IV hernias (75% and 50%, respectively). Gastroesophageal reflux was concomitantly diagnosed in 50%, while concurrent congenital anomalies existed in 36%. A correct initial diagnosis was made in only 29% of cases. The diagnosis was most often established by UGI study (64%). The method of repair was laparoscopy in 21%, and laparotomy in 71%. An antireflux procedure was done in 13 (93%) patients. Long-term follow up data was available for 86% of patient. During follow-up, one patient recurred and one required sequential pneumatic esophageal dilations. There were no mortalities. ConclusionsCPEH is a rare entity often associated with gastroesophageal reflux disease and other congenital anomalies. Prognosis is excellent, but awareness of this anomaly may lead to earlier diagnosis.

Bilateral Bochdalek hernias associated with severe aortic tortuosity and aberrant right subclavian artery

Although Bochdalek hernia is the most common congenital diaphragmatic hernia in adults, bilateral occurrence is rare. To the best of our knowledge, only case reports on Bochdalek hernia and its associated pathologies have been previously published. Herein, we present the case of a 27-year-old man with bilateral Bochdalek hernias, which were detected incidentally. The bilateral Bochdalek hernias were found to be associated with severe aortic tortuosity and aberrant right subclavian artery.

Sonographic findings of a Bochdalek hernia: The importance of ring‐down artifacts

Bochdalek hernia is the most common congenital diaphragmatic hernia. It may be incidentally identified on CT. We report the sonographic findings in a case of Bochdalek hernia, which showed ring-down artifact posterior to the herniated intra-abdominal fat.

Prenatal diagnosis of intrathoracic stomach (gastric herniation)

Intrathoracic stomach is a rare and serious congenital abnormality. The anomaly may be complicated by gastric volvulus and can lead to ischemic gastric infarction in the neonate. If diagnosed antenatally, neonatal management can be planned in advance so as to reduce morbidity. This anomaly must be differentiated from the more common congenital diaphragmatic hernia, as associated pulmonary hypoplasia is common in the latter and rare with gastric herniation. We report an infant born to a mother with Marfan's syndrome with the antenatal diagnosis of intrathoracic stomach. The ultrasound and magnetic resonance imaging features of this congenital abnormality are described. A review of the literature would indicate that this is the first case report of gastric volvulus diagnosed in utero.