Radiological Diagnosis Of Congenital Diaphragmatic Hernia

Dr. GUDDI AGRAWAL, Dr. SUYASH KULKARNI,Dr. (Mrs.) P. S. PENDHARKAR, Prof. & Head,Dr. (Mrs.) B. D. SONAWANE, Asso. Prof.
Dr. S. Z. SORTE, Asso. Prof.,Dr. R. R. KHANDELWAL, Hon. Asso. Prof.,Dr. SURESH PHATAK, Hon. Asso. Prof.
Dr. DHANASHREE DANDE, Asst. Lect. DEPT. OF RADIOLOGY, INDIRA GANDHI MEDICAL COLLEGE, NAGPUR.

CASE : 22 years old female G2P1 with h/o amenorrhoea since 28 weeks.

USG : Routine ANC check-up

E/o Multiple cystic lesions in left thoracic cavity, displacing the mediastinal structures towards right.

E/o peristaltic movements seen in the cystic lesion s/o bowel loops.

No E/o any congenital lesion

Liquor adequate

Thoracic and abdominal circumferance not correlating with BPD and FL findings.

POSTNATAL FOLLOW-UP :

Chest Radiograph of baby shows homogenous opacity seen in left hemithorax displacing the mediastinal structures to right.

Barium study shows barium filled opaque bowel loops in the left hemithorax.

DIAGNOSIS :

USG : Can be diagnosed early upto 17^th week.

Fluid filled bowel loops in chest.

Mediasternal shift towards opposite side.

Peristalsis seen in bowel loops.

POSTNATAL :

X RAY CHEST PA VIEW.

Bowel loops in thoracic cavity.

Mediastinal shift towards opposite side.

Loops seen in thoracic cavity between spine and lateral wall.

LATERAL VIEW :

Focal bulge centered 4.5 cm anterior to posterior diaphragmatic insertion

BARIUM STUDY :

For confirmation of presence of bowel loops.

CT : Soft tissue / Fatty mass prodruding posterolaterally through hemidiaphragm.

CONGENITAL DIAPHRAGMATIC HERNIA : 2 types

1. Foramen of Bochdalek Hernia
2. Foramen of Morgagni Hernia

DIAGRAM :

BOCHDALEK HERNIA

• Commonest type
• Posterolaterally, more on left side.
• Organs herniating –
  • Small intestine 88 %
  • Spleen 48 %
  • Stomach 60 %
  • Colon 56 %
  • Liver 51 %

  Associated With:

• Anencephaly
• Hydrocephalous
• Omphalocele
• Oesophageal atresia
• Trisomy 13 & 18

MORGAGNI HERNIA

• Mostly present in adulthood.
• Most common on right side.
• Organs herniating:

• Small Intestine
• Omentum
• Colon
• Liver

• Associated anomalies

• Abnormal rotation of gut.
• Trisomy 13 & 18.

DIAGNOSIS

X-ray Chest : Enlarged deformed cardiac shadow with gas filled bowel loops in it.

Lateral View : Herniated mass is seen in anterior thoracic segment, displacing the heart and great vessels dorsally.

Barium Study :

For confirmation of barium filled bowel loops.

CT and MRI : Confirmatory

REFERENCES:

• Diagnostic Radiology: Grainger & Allison, Vol. I 239 – 294
• Caffey's Pediatric X-ray diagnosis – 218 (PN)
• Diagnostic Ultrasound – Rumack Vol II – 1071
• Nelson's Textbook of Paediatrics.