*1-day-old infant with respiratory distress.
What is the most likely diagnosis?
Answer
Answer: Congenital diaphragmatic hernia
Case Discussion:
CXR determined herniation of multiple air-filled loops of bowel into left thoracic cavity through diaphragm with displacement of mediastinum towards right. Barium study showed barium-filled loops of bowel into right thoracic cavity. Gasless abdomen is also noted. Surgery was performed and diagnosis of congenital diaphragmatic hernia was confirmed.
Diaphragmatic hernias are divided into two main categories: congenital diaphragmatic defects and acquired diaphragmatic defects.
Congenital (rare)
Congenital diaphragmatic hernias occur due to embryologic defect in the diaphragm. There are two main kinds of them.
• Bochdalek hernia: most common, located posteriorly and typically presents earlier (in infancy)
• Morgagni hernia: less common, smaller, located anteriorly and presents later
Acquired (common)
•traumatic diaphragmatic rupture
•hiatus hernia
•iatrogenic
Chest radiograph
indistinct diaphragm with opacification of the hemithorax
scaphoid abdomen
deviation of lines (endotracheal tube, nasogastic tube, umbilical arterial-venous catheter)
References:
1. Mullins ME, Stein J, Saini SS et-al. Prevalence of incidental Bochdalek’s hernia in a large adult population. AJR Am J Roentgenol. 2001;177 (2): 363-6.
2. Sakurai M, Donnelly LF, Klosterman LA et-al. Congenital diaphragmatic hernia in neonates: variations in umbilical catheter and enteric tube position. Radiology. 2000;216 (1): 112-6.