Congenital diaphragmatic hernia fetal ultrasound

Antenatal ultrasoundIndirect sonographic findings that should prompt a search for CDH include 7:polyhydramnioscardiomediastinal shift +/- abnormal cardiac axisinability to demonstrate the normal stomach bubbleThe study should be performed in the true transverse plane. Sonographic diagnosis of CDH can be made from the following findings 7,8:absent bowel loops in the abdomenintrathoracic herniation of the liver; noted in up to 85% of cases and is associated with a worse prognosisperistaltic bowel movements in the chestherniation into the chest may occur intermittentlyabdominal circumference is reduced (due to herniation of organs)left-sided CDHstomach and small bowel (echo-free) at the same transverse level as the heart on four-chamber view: this makes left sided hernias comparatively easier to detect on ultrasound (as opposed to herniation of echogenic liver on the right side)stomach and small bowel superior to the inferior margin of the scapulaleftward displacement of the gallbladder right-sided CDHcolor Doppler studyleftward bowing of the umbilical segment of the portal veinportal branches to the lateral segment of the left hepatic lobe coursing towards or above the diaphragmgallbladder present above the diaphragmechogenic space between the left heart border and stomach representing the left hepatic lobeAlthough classically considered a cystic echogenic lung mass, there are reports of CDH appearing initially as a solid echogenic lung mass that evolves in appearance with advancing gestation 9.The observed-to-expected lung-to-head ratio (O/E LHR) may be calculated and correlates with the degree of pulmonary hypoplasia. Studies suggest that the degree of lung hypoplasia can be used to predict survival rates and the numbers from the Antenatal-CDH-Registry group that apply to isolated left-sided CDH and liver herniation are shown below 10,11:O/E LHR <15% (extreme pulmonary hypoplasia): virtually no chance of survivalO/E LHR 15-25% (severe pulmonary hypoplasia): predicted survival ≈ 15%O/E LHR 26-45% (moderate pulmonary hypoplasia): predicted survival 30-75%O/E LHR >45% (mild pulmonary hypoplasia): very likely to surviveMRI