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Congenital diaphragmatic hernia--a review of pre- and postoperative chest radiology
1Leeds General Infirmary.
Insights
Radiographic features in congenital diaphragmatic hernia (CDH) predict outcomes. Neonatal CDH presentation shows typical preoperative signs, with contralateral pneumothorax and absent lung indicating poor prognosis, while ipsilateral lung presence suggests survival.
Area of Science:
- Pediatric Radiology
- Neonatal Surgery
- Thoracic Surgery
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring prompt diagnosis and management.
- Radiographic assessment plays a crucial role in evaluating CDH severity and predicting patient outcomes.
Purpose of the Study:
- To analyze the clinical and radiographic features of congenital (Bochdalek) diaphragmatic hernias in infants and children.
- To identify radiographic indicators of prognosis in neonatal CDH presenters.
Main Methods:
- Retrospective review of clinical and radiographic data for 63 infants and children with CDH.
- Analysis of preoperative and postoperative radiographic findings, correlating them with clinical presentation and outcomes.
Main Results:
- Preoperative radiographs in neonatal CDH typically showed characteristic features, with one exception.
- Poor prognostic indicators included contralateral pneumothorax, absent contralateral aerated lung, and intrathoracic stomach.
- Presence of ipsilateral aerated lung was consistently associated with survival.
- Postoperative findings included ipsilateral pneumothorax, gradual lung expansion, diaphragmatic elevation, and pleural effusion.
- Delayed presenters showed complete lung expansion and no pulmonary hypoplasia on initial postoperative radiographs.
Conclusions:
- Radiographic features are valuable for predicting prognosis in congenital diaphragmatic hernia.
- Specific preoperative findings can identify high-risk neonatal CDH cases.
- Postoperative radiographic patterns differ between neonatal and delayed CDH presenters.
Abstract:
The clinical and pre- and postoperative radiographic features of 63 babies who presented with congenital (Bochdalek) diaphragmatic hernias were reviewed. Fifty-five babies presented in the neonatal period and eight in later childhood. For neonatal presenters, the preoperative radiographic features were typical in all cases but one (presented with persistent right pleural effusion). Features associated with a poorer prognosis included the presence of a contralateral pneumothorax, absence of contralateral aerated lung and an intrathoracic site for the stomach. Identification of ipsilateral aerated lung was associated with survival in all cases. Typical postoperative features included an ipsilateral pneumothorax, gradual expansion of the lung, gradual elevation of the hemidiaphragm and pleural effusion. Follow-up films demonstrated reduced vascularity in the ipsilateral lung which was commonly smaller than the contralateral lung. The postoperative radiographic features for delayed presenters differed in that lung expansion was usually complete on the first postoperative radiograph and there was no radiographic evidence of pulmonary vascular hypoplasia.