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Congenital Diaphragmatic Hernia, left-sided Bochdalek (posterolateral)

Magee CDM - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Congenital Diaphragmatic Hernia, left-sided Bochdalek (posterolateral)

History: Newborn male baby status-post induced vaginal delivery in early AM at 37 weeks EGA with Bochdalek (posterolateral) left-sided congenital diaphragmatic hernia (CDH) first discovered on ultrasound exam at 30 weeks EGA and diagnosed with in utero MRI @ 33 weeks EGA.

Findings: MRI at 33 weeks revealed CDH with small bowel and stomach herniation into left hemithorax without evidence of liver herniation. Left pulmonary hypoplasia secondary to CDH and herniation of abdominal contents. Portable chest/abd plain film status post delivery @ 0455 shows patient has ET and OG tubes with adequate placement of each. OG tube continues into stomach with gastric bubble visualized in left chest, no left hemidiaphragm visualized. Trachea deviated to the right w/ mediastinal right-shift present. Questionable right-sided pneumothorax at base as well. Left hemithorax filled w/ radio-opaque mass c/w herniated abdominal contents. Follow up portable chest/abd radiograph @ 0530 revealed similar findings as seen at birth, with umbilical artery catheter in descending aorta and umbilical vein catheter in IVC - both in good position. Of note, course of umbilical vein catheter appears to deviate significantly to the left in the abdomen before returning to normal location of IVC. This is likely due to altered anatomy secondary to CDH. Left lateral decubitus film @ 0615 shows right-sided pneumonthorax present, no new changes otherwise.

Ddx: diaphragmatic eventration, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, bronchogenic cysts, bronchial atresia, enteric cysts, and teratomas

Dxhow: confirmed on in utero MRI, plain film radiographs at birth, correlated with physical exam, vital signs

Exam: Respiratory distress, cyanosis, tachypnea

No MeSH data available.


sequence of T1w w/ gad MR images of in utero fetus @ 33wks EGA w/ CDH into left hemithorax, displaced mediastinum/heart;  left hemithorax heterogeneous, c/w small bowel - not liver.
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MPX1584_synpic33010: sequence of T1w w/ gad MR images of in utero fetus @ 33wks EGA w/ CDH into left hemithorax, displaced mediastinum/heart; left hemithorax heterogeneous, c/w small bowel - not liver.


Congenital Diaphragmatic Hernia, left-sided Bochdalek (posterolateral)

Magee CDM - MedPix (2007)

sequence of T1w w/ gad MR images of in utero fetus @ 33wks EGA w/ CDH into left hemithorax, displaced mediastinum/heart;  left hemithorax heterogeneous, c/w small bowel - not liver.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1584&req=5

MPX1584_synpic33010: sequence of T1w w/ gad MR images of in utero fetus @ 33wks EGA w/ CDH into left hemithorax, displaced mediastinum/heart; left hemithorax heterogeneous, c/w small bowel - not liver.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Congenital Diaphragmatic Hernia, left-sided Bochdalek (posterolateral)

History: Newborn male baby status-post induced vaginal delivery in early AM at 37 weeks EGA with Bochdalek (posterolateral) left-sided congenital diaphragmatic hernia (CDH) first discovered on ultrasound exam at 30 weeks EGA and diagnosed with in utero MRI @ 33 weeks EGA.

Findings: MRI at 33 weeks revealed CDH with small bowel and stomach herniation into left hemithorax without evidence of liver herniation. Left pulmonary hypoplasia secondary to CDH and herniation of abdominal contents. Portable chest/abd plain film status post delivery @ 0455 shows patient has ET and OG tubes with adequate placement of each. OG tube continues into stomach with gastric bubble visualized in left chest, no left hemidiaphragm visualized. Trachea deviated to the right w/ mediastinal right-shift present. Questionable right-sided pneumothorax at base as well. Left hemithorax filled w/ radio-opaque mass c/w herniated abdominal contents. Follow up portable chest/abd radiograph @ 0530 revealed similar findings as seen at birth, with umbilical artery catheter in descending aorta and umbilical vein catheter in IVC - both in good position. Of note, course of umbilical vein catheter appears to deviate significantly to the left in the abdomen before returning to normal location of IVC. This is likely due to altered anatomy secondary to CDH. Left lateral decubitus film @ 0615 shows right-sided pneumonthorax present, no new changes otherwise.

Ddx: diaphragmatic eventration, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, bronchogenic cysts, bronchial atresia, enteric cysts, and teratomas

Dxhow: confirmed on in utero MRI, plain film radiographs at birth, correlated with physical exam, vital signs

Exam: Respiratory distress, cyanosis, tachypnea

No MeSH data available.