Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions

Area of Science:

• Pediatric Radiology
• Thoracic Imaging
• Congenital Abnormalities

Background:

• The diaphragm is a critical structure for respiration and a landmark for staging pediatric diseases.
• Children can present with various diaphragmatic pathologies, including congenital anomalies, trauma, and tumors.
• Congenital diaphragmatic hernias (CDHs) remain a significant cause of morbidity and mortality in neonates.

Purpose of the Study:

• To review the spectrum of diaphragmatic abnormalities in children.
• To highlight the importance of radiologic imaging in diagnosing and managing these conditions.
• To emphasize the role of radiologists in understanding diaphragmatic embryology, anatomy, and pathology.

Main Methods:

• Review of congenital diaphragmatic abnormalities (aplasia, hypoplasia, eventration, hernias).
• Discussion of traumatic diaphragmatic injuries and primary/secondary tumors.
• Emphasis on imaging modalities like ultrasonography for diaphragmatic paralysis.

Main Results:

• Congenital abnormalities, particularly CDHs, have significant associated morbidity and mortality.
• Newer surgical techniques introduce novel postoperative complications and imaging findings.
• Diaphragmatic trauma in children typically signifies high-impact injury.
• Primary diaphragmatic tumors are rare, with rhabdomyosarcoma being most common.

Conclusions:

• A comprehensive understanding of diaphragmatic embryology, anatomy, and variations is essential for radiologists.
• Familiarity with the imaging appearances of pediatric diaphragmatic pathologies is crucial for accurate diagnosis and patient management.
• Despite improved survival rates, CDHs require careful monitoring due to persistent risks.