Hosting 718 files, 2916 images, and 4 contributors.

 
Random Case

Menkes Syndrome
Joseph Junewick, MD FACR
over 4 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Right-sided Congenital Diaphragmatic Hernia

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 7 years ago
Tags:
Modality/Study Types: CR CT
Activities:
Adobe32 PDF Imagej32 ImageJA

History

3 month old with minor difficulty breathing.


Case Images


Diagnosis

Right-sided Congenital Diaphragmatic Hernia (delayed Morgagni type)

Findings

CR – Right-sided mediastinal mass with diminished hepatic shadow in right upper quadrant.

CT – Axial, sagittal and coronal images demonstrate herniation of the liver through an anterior and medial diaphragmatic defect.

Discussion

Congenital diaphragmatic hernia (CDH) is sporadic and usually occurs by the 2nd trimester. Herniation of abdominal contents into the chest through a diaphragmatic defect results in pulmonary hypoplasia, lung immaturity, left heart hypoplasia and pulmonary hypertension. The diaphragmatic defect may be posterolateral (Bochdalek), anteromedial (Morgagni) or central tendon (septum transversum). Bochdalek defects are most common, accounting for 80% of hernias. Most hernias are left sided.

Delayed CDH is commonly seen on the right side (the liver temporarily blocks the extension of abdominal viscera into the chest). Delayed hernia has also been reported with group B beta-hemolytic streptococcal pneumonia.

Anomalies are associated with CDH in up to half of patients and include ventriculoseptal defect, vascular ring, aortic coarctation, genitourinary abnormalities, neural tube defects, esophageal atresia, omphalocele, cleft palate and chromosomal abnormalities (trisomy 12, 18 and 21). Early complications of CDH survivors include chylous effusion and bronchopulmonary dysplasia; late complications include chest wall deformities (pectus and scoliosis), bowel dysmotility, and gastroesophageal reflux.

Reference

Slovis TL and Bulas DI. Congenital and acquired (most causing respiratory distress) of the neonatal lung and thorax. Caffey’s Pediatric Diagnostic Imaging, 11th Ed. 2008.



Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare