Congenital Diaphragmatic Hernias Workup

  • Author: Daniel S Schwartz, MD, FACS; Chief Editor: Jeffrey C Milliken, MD   more...
 
Updated: Jan 19, 2012
 

Laboratory Studies

  • Maternal serum alpha-fetoprotein (AFP): Low levels have been associated with CDH. However, low AFP also is observed with trisomy 18 and trisomy 21, so a low AFP level alone is not diagnostic.
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Imaging Studies

  • Chest radiograph[11]
    • Congenital (early diagnosis) - Bowel and stomach in the chest cavity, shifting of the mediastinum (usually to the right)
    • See the image below.Anteroposterior (AP) view of the chest in a patienAnteroposterior (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.
    • Congenital (late diagnosis) - Suspicious mass incidentally found on chest radiograph
  • Prenatal diagnosis of CDH: A level 3 ultrasound examination is the criterion standard for reaching a diagnosis of CDH in utero. 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.
  • MRI can be utilized to show a fetal lung volume and, in some instances, to help determine postnatal mortality.
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Contributor Information and Disclosures
Author

Daniel S Schwartz, MD, FACS  Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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: Medscape Salary Employment

Daniel S Schwartz, MD, FACS  Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital

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

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

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, Southwest Oncology Group, and Western Surgical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Jason M Johnson, DO; Sidney R Steinberg, MD, FACS; and Eric Jensen, MD, FACS, to the development and writing of this article.

References

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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.
 
 
 
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