eMedicine Specialties > Radiology > Pediatrics
Congenital Diaphragmatic Hernia: Imaging
Updated: Jul 16, 2008
Radiography
Findings
Anteroposterior (AP) chest radiograph of a right-sided congenital diaphragmatic hernia (CDH) shows a mediastinal shift and lung compression caused by herniation of the liver and multiple bowel loops.
Anteroposterior (AP) chest radiograph of a right-sided congenital diaphragmatic hernia (CDH) shows herniation of the liver and bowel loops into the right hemithorax, with a shift of the heart and mediastinum to the left side.
Anteroposterior (AP) view of the abdomen in a patient with a congenital diaphragmatic hernia (CDH) shows a gasless pattern caused by herniation of bowel loops into the right hemithorax.
Anteroposterior (AP) view of the chest in a patient with a congenital diaphragmatic hernia (CDH) shows a left-sided Bochdalek hernia.
Anteroposterior (AP) view of the chest in a patient with a congenital diaphragmatic hernia (CDH) shows herniation of bowel loops into the left hemithorax, with a shift of the heart and mediastinum to the right side.
After the repair of a congenital diaphragmatic hernia, an ipsilateral ex vacuo pneumothorax is a universal finding on all chest radiographs obtained immediately after surgery in neonates. This finding is unaffected by the use of a chest drain.2
The degree of expansion of the ipsilateral lung is variable. Final radiographs at discharge usually demonstrate a mild ipsilateral shift of the mediastinum. In most cases, this indicates increased pulmonary hypoplasia in the ipsilateral lung.
The postoperative radiographic course for patients presenting in later childhood is different. The ipsilateral lung is frequently fully expanded on the first postoperative radiograph, and the diaphragm usually occupies a normal position. These findings indicate a lesser degree of pulmonary hypoplasia.2
Computed Tomography
Findings
In adults, previously undiagnosed Bochdalek hernias are most frequently identified when patients undergo CT scanning for reasons that appear to be unrelated to the hernia.
In adults, Bochdalek hernias usually contain retroperitoneal fat or a kidney.7,11,12
Degree of Confidence
Some believe that, with the routine use of thin-section CT scanning on modern imaging equipment, the prevalence and characteristics of late-presenting Bochdalek hernia can be more accurately estimated12,13 ; however, small Bochdalek defects may occur in as many as 6% of older adults.
Magnetic Resonance Imaging
Findings
Regarding the prenatal MRI evaluation of congenital diaphragmatic hernia, advances in MRI provide high-quality images of the intrathoracic organs. MRIs can clearly depict diaphragmatic discontinuity, a fetal compressed lung, and connecting bowel segments between the abdomen and chest.14
Degree of Confidence
MRI can accurately depict congenital diaphragmatic hernia (CDH), and it permits an easy diagnosis. MRI findings can be used to differentiate CDH from other chest masses; it is superior to ultrasonography in demonstrating the position of the fetal liver above or below the diaphragm.
Ultrasonography
Findings
Sonogram of a right-sided congenital diaphragmatic hernia shows the liver herniating through the defect.
Pregnant women carrying a fetus with congenital diaphragmatic hernia (CHD) are often referred for sonography first because of suspected polyhydramnios. The definite sonographic diagnosis of fetal CDH relies on the visualization of abdominal organs in the chest; the sonographic hallmark of CDH is a fluid-filled mass just behind the left atrium and ventricle in the lower thorax, as seen on a transverse view.
Other sonographic features of CDH include polyhydramnios, a mediastinal shift, a small fetal abdominal circumference, and the absence of the stomach in the abdomen.
In a right-sided hernia, the right lobe of the liver alone may be herniated, or associated hydrothorax and ascites may be observed.9
More on Congenital Diaphragmatic Hernia |
| Overview: Congenital Diaphragmatic Hernia |
 Imaging: Congenital Diaphragmatic Hernia |
| Follow-up: Congenital Diaphragmatic Hernia |
| Multimedia: Congenital Diaphragmatic Hernia |
| References |
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References
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Pironi D, Palazzini G, Arcieri S, Candioli S, Manigrasso A, Panarese A, et al. Laparoscopic diagnosis and treatment of diaphragmatic Morgagni hernia. Case report and review of the literature. Ann Ital Chir. Jan-Feb 2008;79(1):29-36. [Medline].
Pelizzo G, Lembo MA, Franchella A. Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings. Abdom Imaging. May-Jun 2001;26(3):306-8. [Medline].
Mullins ME, Stein J, Saini SS, Mueller PR. Prevalence of incidental Bochdalek's hernia in a large adult population. AJR Am J Roentgenol. Aug 2001;177(2):363-6. [Medline].
REED JO, LANG EF. Diaphragmatic hernia in infancy. Am J Roentgenol Radium Ther Nucl Med. Sep 1959;82:437-49. [Medline].
Cannie M, Jani J, De Keyzer F, Van Kerkhove F, Meersschaert J, Lewi L, et al. Magnetic resonance imaging of the fetal lung: a pictorial essay. Eur Radiol. Jul 2008;18(7):1364-74. [Medline].
Further Reading
Keywords
congenital diaphragmatic hernia, CDH, Bochdalek hernia, posterolateral Bochdalek hernia, anterior Morgagni hernia, hiatus hernia, hiatal hernia
