Diaphragmatic hernia

Case contributed by Mr. Mujeeb Khader

Presentation

6 weeks old female with suspected diaphragmatic hernia. Good air entry on the right side without any added sounds. Good air entry on the upper left zone, no air entry on the mid and lower left zones.

Patient Data

Age: 6 weeks
Gender: Female
X-ray

Left sided diaphragmatic hernia with herniation of bowel loops in hemithorax.

CT

Herniation of the stomach into the thorax with downward and posterior pointing of the fundus, followed by the greater curvature seen on the superior aspect and folding over the proximal of the stomach to lay anteriorly with the antrum pointing downwards. These features are concerning for the mesentro-axial volvulus of the stomach.

Fluoroscopy

Herniation of the stomach into the left hemithorax with folding of the stomach along the mesentero-axial border keeping with incomplete mesentero-axial volvus. The contrast is collected within the fundus of the stomach with the body and greater curvature lying superiorly and anteriorly leading to the pylorus. Noted the contrast not passing through the pylorus.

Case Discussion

Diaphragmatic hernia is a birth defect occurring during the baby's development in the womb. As the diaphragm is not fully developed, certain organs, such as the stomach, small intestine, spleen, part of the liver and the kidney may move into the thoracic cavity.

It usually affects one side predominantly the left one. The lung tissue and blood vessels of the affected area may not develop normally. About 40 to 50% of babies also have other problems with this condition.

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