Presentation
Respiratory distress at birth. No pre-natal ultrasound.
Patient Data
There are multiple lucencies within the left hemithorax. The left hemidiaphragm is not visible and the mediastinum is pushed to the right. The NG tube descends in the midline and its tip is projected below the inferior extent of the film - within the abdomen.
Features here are of diaphragmatic hernia.
Case Discussion
Congenital diaphragmatic hernias are serious deformities because of the risk of bowel injury, volvulus and strangulation. However, the additional consequence of large hernias is compressive pulmonary hypoplasia and persistent respiratory compromise after hernial reduction and closure of the defect.
The reduction may be performed thoracoscopically with positive pressure, or via a laparotomy. The closure may be primary (if small) or require a patch if larger.
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