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Congenital Diaphragmatic Hernia
Emily Edwards, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Congenital diaphragmatic hernia (CDH)
          • Definitions

            • Abdominal contents herniate into chest via diaphragmatic defect
              • Foramen of Bochdalek: Posterior defect
                • Most common type in fetuses
              • Foramen of Morgagni: Anterior defect
                • More often right sided
              • Uncommonly, herniation through esophageal hiatus or diaphragmatic agenesis

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR Findings

                • Imaging Recommendations

                  • Calculations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Perinatology: Lung-to-head ratio calculator. Accessed June 26, 2020. http://perinatology.com/calculators/LHR.htm
                                  2. Abbasi N et al: Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American fetal therapy network (NAFTNet). Prenat Diagn. 40(3):342-50, 2020
                                  3. Dütemeyer V et al: Prenatal prediction of postnatal survival in fetuses with congenital diaphragmatic hernia using MRI: lung volume measurement, signal intensity ratio, and effect of experience. J Matern Fetal Neonatal Med. 1-9, 2020
                                  4. Meyers ML et al: Fetal lung volumes by MRI: normal weekly values from 18 through 38 weeks' gestation. AJR Am J Roentgenol. 211(2):432-8, 2018
                                  5. Oluyomi-Obi T et al: Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg. 52(5):881-8, 2017
                                  6. Al-Maary J et al: Fetal tracheal occlusion for severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis of survival. Ann Surg. 264(6):929-33, 2016
                                  7. Basta AM et al: Fetal stomach position predicts neonatal outcomes in isolated left-sided congenital diaphragmatic hernia. Fetal Diagn Ther. 39(4):248-55, 2016
                                  8. Kastenholz KE et al: Correlation of observed-to-expected MRI fetal lung volume and ultrasound lung-to-head ratio at different gestational times in fetuses with congenital diaphragmatic hernia. AJR Am J Roentgenol. 206(4):856-66, 2016
                                  9. Sananes N et al: Improving the prediction of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia by direct and indirect sonographic assessment of liver herniation. J Ultrasound Med. 35(7):1437-43, 2016
                                  10. Lusk LA et al: Fetal ultrasound markers of severity predict resolution of pulmonary hypertension in congenital diaphragmatic hernia. Am J Obstet Gynecol. 213(2):216.e1-8, 2015
                                  11. Zamora IJ et al: Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). J Pediatr Surg. 49(5):688-93, 2014
                                  12. Debus A et al: Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease. Radiology. 266(3):887-95, 2013
                                  13. Jani JC et al: Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol. 39(1):2-6, 2012
                                  14. Mehollin-Ray AR et al: Fetal MR imaging of congenital diaphragmatic hernia. Radiographics. 32(4):1067-84, 2012
                                  15. Alfaraj MA et al: Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol. 205(1):43.e1-8, 2011
                                  16. Knox E et al: Prenatal detection of pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis of diagnostic studies. J Matern Fetal Neonatal Med. 23(7):579-88, 2010
                                  17. Laudy JA et al: Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn. 23(8):634-9, 2003
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Congenital diaphragmatic hernia (CDH)
                                          • Definitions

                                            • Abdominal contents herniate into chest via diaphragmatic defect
                                              • Foramen of Bochdalek: Posterior defect
                                                • Most common type in fetuses
                                              • Foramen of Morgagni: Anterior defect
                                                • More often right sided
                                              • Uncommonly, herniation through esophageal hiatus or diaphragmatic agenesis

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • MR Findings

                                                • Imaging Recommendations

                                                  • Calculations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Perinatology: Lung-to-head ratio calculator. Accessed June 26, 2020. http://perinatology.com/calculators/LHR.htm
                                                                  2. Abbasi N et al: Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American fetal therapy network (NAFTNet). Prenat Diagn. 40(3):342-50, 2020
                                                                  3. Dütemeyer V et al: Prenatal prediction of postnatal survival in fetuses with congenital diaphragmatic hernia using MRI: lung volume measurement, signal intensity ratio, and effect of experience. J Matern Fetal Neonatal Med. 1-9, 2020
                                                                  4. Meyers ML et al: Fetal lung volumes by MRI: normal weekly values from 18 through 38 weeks' gestation. AJR Am J Roentgenol. 211(2):432-8, 2018
                                                                  5. Oluyomi-Obi T et al: Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg. 52(5):881-8, 2017
                                                                  6. Al-Maary J et al: Fetal tracheal occlusion for severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis of survival. Ann Surg. 264(6):929-33, 2016
                                                                  7. Basta AM et al: Fetal stomach position predicts neonatal outcomes in isolated left-sided congenital diaphragmatic hernia. Fetal Diagn Ther. 39(4):248-55, 2016
                                                                  8. Kastenholz KE et al: Correlation of observed-to-expected MRI fetal lung volume and ultrasound lung-to-head ratio at different gestational times in fetuses with congenital diaphragmatic hernia. AJR Am J Roentgenol. 206(4):856-66, 2016
                                                                  9. Sananes N et al: Improving the prediction of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia by direct and indirect sonographic assessment of liver herniation. J Ultrasound Med. 35(7):1437-43, 2016
                                                                  10. Lusk LA et al: Fetal ultrasound markers of severity predict resolution of pulmonary hypertension in congenital diaphragmatic hernia. Am J Obstet Gynecol. 213(2):216.e1-8, 2015
                                                                  11. Zamora IJ et al: Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). J Pediatr Surg. 49(5):688-93, 2014
                                                                  12. Debus A et al: Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease. Radiology. 266(3):887-95, 2013
                                                                  13. Jani JC et al: Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol. 39(1):2-6, 2012
                                                                  14. Mehollin-Ray AR et al: Fetal MR imaging of congenital diaphragmatic hernia. Radiographics. 32(4):1067-84, 2012
                                                                  15. Alfaraj MA et al: Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol. 205(1):43.e1-8, 2011
                                                                  16. Knox E et al: Prenatal detection of pulmonary hypoplasia in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis of diagnostic studies. J Matern Fetal Neonatal Med. 23(7):579-88, 2010
                                                                  17. Laudy JA et al: Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn. 23(8):634-9, 2003