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Congenital Diaphragmatic Hernias Workup

  • Author: Daniel S Schwartz, MD, FACS; Chief Editor: Jeffrey C Milliken, MD  more...
 
Updated: Oct 28, 2014
 

Imaging Studies

On chest radiography,[12] CDH may be signaled at an early stage by a finding of bowel and stomach in the chest cavity and shifting of the mediastinum (usually to the right). (See the image below.) At a later stage, CDH may be signaled by a suspicious mass incidentally found on a chest radiograph.

Anteroposterior view of chest in patient with congAnteroposterior view of chest in patient with congenital diaphragmatic hernia shows herniation of bowel loops into left hemithorax, with right shift of heart and mediastinum.

For reaching a diagnosis of CDH in utero, a level 3 ultrasound examination is the criterion standard. Features indicative of CDH are polyhydramnios, an absent or intrathoracic stomach bubble, mediastinal and cardiac shift away from the side of herniation, and (rarely) fetal hydrops.

Magnetic resonance imaging (MRI) can be utilized to show a fetal lung volume and, in some instances, to help determine postnatal mortality.[13]

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Laboratory Studies

Low levels of maternal serum alpha-fetoprotein (AFP) have been associated with congenital diaphragmatic hernia (CDH). However, decreased AFP also is observed with trisomy 18 and trisomy 21; thus, a low AFP level, by itself, is not diagnostic of CDH.

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Contributor Information and Disclosures
Author

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, FACS is a member of the following medical societies: Society of Thoracic Surgeons, Western Thoracic Surgical Association, American College of Chest Physicians, American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, FACS is a member of the following medical societies: Society of Thoracic Surgeons, Western Thoracic Surgical Association, American College of Chest Physicians, American College of Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey C Milliken, MD Chief, Division of Cardiothoracic Surgery, University of California at Irvine Medical Center; Clinical Professor, Department of Surgery, University of California, Irvine, School of Medicine

Jeffrey C Milliken, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, California Medical Association, International Society for Heart and Lung Transplantation, Phi Beta Kappa, Society of Thoracic Surgeons, SWOG, Western Surgical Association

Disclosure: Nothing to disclose.

Acknowledgements

Eric Jensen, MD, FACS Staff General and Pediatric Surgeon, Department of General Surgery, William Beaumont Army Medical Center

Disclosure: Nothing to disclose.

Jason M Johnson, DO Resident Physician, Department of General Surgery, Spartanburg Regional Medical Center

Disclosure: Nothing to disclose.

Sidney R Steinberg, MD, FACS Program Director, Department of General Surgery, Spartanburg Regional Healthcare System; Consulting Surgeon, Department of Surgery, WG Hefner Veterans Affairs Medical Center

Sidney R Steinberg, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Surgical Education, South Carolina Medical Association, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

References
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Anteroposterior view of chest in patient with congenital diaphragmatic hernia shows herniation of bowel loops into left hemithorax, with right shift of heart and mediastinum.
 
 
 
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