Congenital diaphragmatic hernia

Case contributed by Dr Jeremy Jones

Presentation

Increased work of breathing. Term infant. Uncomplicated pregnancy.

Patient Data

Age: 0 days
Gender: Male
Modality: X-ray

The left hemithorax is filled with multiple lucent regions and the diaphragm is not visible. Features here are of a congenital diaphragmatic hernia. The stomach and small bowel have herniated through the diaphragmatic defect.

2 days later

Modality: X-ray

The diaphragmatic defect has not been repaired. The gas in the small bowel has been resorped and the loops of small bowel are now fluid filled and largely invisible on plain film.

Case Discussion

The large left congenital diaphragmatic hernia is visible on day 0 with gas-filed stomach and small bowel in the left hemithorax.

Over the first two days, there was progressive deaeration of the herniated viscera. The mass effect is significant and causes mediastinal shift and compressive atelectasis of the right upper lobe.

Managing these cases is not as simple as pulling down the bowel and sewing up the hole in the diaphragm - there will be assocaited pulmonary hypoplasia because of the lack of pulmonary expansion in utero and respiratory compromise is often severe in cases with large herniae.

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Case Information

rID: 27205
Case created: 23rd Jan 2014
Last edited: 1st Jul 2016
Inclusion in quiz mode: Included

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