Fig. 1
Types of congenital diaphragm hernias. Morgagni hernias are defects in the anterior diaphragm while the more common Bochdalek hernias are in the posterolateral diaphragm (Source: Christopher Coppola)
(h)
Can contain liver, spleen, gastrointestinal tract, and kidney.
(i)
Associated pulmonary hypoplasia.
(i)
Decreased lung mass.
(ii)
Decreased bronchial branching.
(iii)
Decreased alveoli.
(iv)
Decreased total vascular diameter.
(v)
Hypertrophied vascular smooth muscle.
(vi)
Smooth muscle in alveolar vessels.
(vii)
Bilateral lungs affected.
(j)
Factors resulting in persistent fetal circulation in CDH.
(i)
Pulmonary hypoplasia.
(ii)
High pulmonary vascular resistance.
(iii)
Hypoxia.
(iv)
Acidosis.
(v)
Stress.
(k)
Diagnosis:
(i)
Prenatal ultrasound (CDH, polyhydramnios).
(ii)
Respiratory distress after delivery.
(iii)
Scaphoid abdomen/funnel chest.
(iv)
Abdominal x-ray with nasogastric tube, showing tube in chest.
(v)
Ten – 20 percent with delayed presentation.
(l)
Get Clinical Tree app for offline access
Predicting severity of CDH:
(i)
Prenatally diagnosed CDH as a group has worse prognosis than CDH diagnosed after birth.
(ii)
Presence of cardiac defects worsens mortality.
(iii)
Smaller pulmonary artery size (which can be quantified by the McGoon Index) carries worse prognosis.
(iv)
Defects large enough to allow herniation of the stomach into the chest have worse prognosis and have reported to have survival as low as 30 %.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree