Presentation
Congenital diaphragmatic hernia diagnosed on obstetric ultrasound. Fetal MRI for characterization and assessment of lung volumes.
Patient Data
Selected images from ultrasound study performed at 23 weeks demonstrating a left sided CDH.
Left-sided congenital diaphragmatic hernia is noted, containing stomach, and small portions of the splenic flexure of large bowel, spleen and of the left lobe of the liver.
Plainimetric measurements were performed, demonstrating the total lung volume to be 28.5 ml which is approximately 65% of normal mean total lung volume for this gestational age1 and 80% of normal total lung volume based on another set of normal data (Garcia et al, IPR 2016).
The proportion of liver that is herniated above the diaphragm is 18%.
There is no evidence of any hernial sac or fluid separating the left lung base and hernia contents to suggest an extrapleural hernia.
Case Discussion
Left-sided diaphragmatic hernia with calculated observed to expected lung volume of 65-80%, depending on the normative data set used. Percentage of liver herniation of 18%.
Based on the Ruano et al prognostic criteria2 this represents a mild severity hernia with less than 20% likelihood of ECMO requirement and <10% mortality.
Case courtesy of A/Prof Stacy Goergen.
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