Postnatally diagnosed coexisting congenital diaphragmatic hernia with pulmonary sequestration: a report of two cases

Area of Science:

• Medical Science
• Pediatric Surgery
• Neonatology

Background:

• Pulmonary sequestration (PS) and congenital diaphragmatic hernia (CDH) are known co-occurring conditions.
• PS can obscure the prenatal diagnosis of CDH on ultrasonography, leading to delayed identification.
• This masking effect can impact the management and outcomes of affected newborns.

Purpose of the Study:

• To highlight the diagnostic challenge posed by PS masking CDH during prenatal screening.
• To emphasize the importance of considering CDH in cases of isolated prenatally diagnosed PS.
• To recommend appropriate management strategies for infants with suspected coexisting PS and CDH.

Main Methods:

• Presentation of two case studies of newborns with postnatally diagnosed CDH and coexisting PS.
• Review of prenatal ultrasonography findings and postnatal diagnostic confirmation.
• Analysis of the potential role of PS as an "anatomical barrier" affecting lung development.

Main Results:

• In both presented cases, PS was identified prenatally as an isolated lung mass.
• CDH was only confirmed after birth, indicating it was initially overlooked due to the presence of PS.
• Both newborns were stable postnatally, allowing for timely diagnosis and management planning.

Conclusions:

• Pulmonary sequestration can act as a "protector" by preventing herniation and allowing normal lung maturation, but it may obscure coexisting congenital diaphragmatic hernia.
• Prenatal suspicion of PS requires heightened vigilance for potential CDH, necessitating comprehensive parental counseling.
• Infants with suspected coexisting PS and CDH should be delivered at tertiary centers with advanced imaging capabilities to exclude CDH and ensure appropriate care.