Heather Borders, MD
over 5 years ago
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Joseph Junewick, MD FACR
|Diagnostic Category: Developmental or Congenital
|Created: over 5 years ago
|Updated: over 5 years ago
Adolescent with cough; rule out pneumonia.
Diaphragmatic (Bochdalek) Hernia
CR – Contour abnormality and elevation of the left hemidiaphragm with dextro-positioning of the mediastinum.
CT – Axial and sagittal and coronal reformats confirm defect of the posterior aspect of the left hemidiaphragm with stomach, small bowel and colon in the hernia.
The diaphragm is formed by 3 segments, the septum transversum anteromedially, a mesenteric confluence posteromedially, and the pleuroperitoneal membrane laterally. Striated muscle enventually becomes invested in the pleuroperitoneal membrane.
Diaphragmatic hernias are most often related to congenital deficiency, although post-traumatic or post-inflammatory etiologies are encountered in children. The most common congenital defect is the result of incomplete closure of the pleuorperitoneal membrane. Large defects present early (usually at birth) and small defects may be asymptomatic or gradually enlarge and become symptomatic with age.
Most hernias involve the left hemidiaphragm (80%); 1% are bilateral. Delayed presentation is associated with a well-defined hernia sac. Presenting symptoms are often vague but usually related to respiratory or gastrointestinal systems. The bowel should be studied to exclude malrotation.
Elhalaby E, AboSikeena MH. Delayed presentation of congenital diaphragmatic hernias. Pediatric Surg (2002); 18:480-485.