Prenatal diagnosis of congenital diaphragmatic hernia

Introduction

Hernia diaphragmatic dome (HCD) affects about one child born alive in 3000. A very early closure defect of the diaphragm by lack of closure of pleuroperitoneal canal is responsible for impaired lung development and physiology. Due to the different pressure between the thorax and the abdomen, the abdominal organs in the thorax moves causing insufficient lung development. The diagnosis of congenital diaphragmatic hernia occurs most often during a routine ultrasound.

Objective

The aim of this study is to describe two cases of Hernia diaphragmatic dome and show the importance of ultrasound examination in its diagnosis.

Method

We present two cases of HCD diagnosed by the antenatal ultrasound examination

Case 1

a 32 year -old woman without any antecedent, attented our department of Obstetrics and Gynecology at Ben Arous Hospital (tunisia) for morphological ultrasound examination at 24 weeks of amenorrhea. The ultrasound examination was performed by suprapubic approach. It was a left diaphragmatic hernia. We had noted the absence of stomach in the abdomen in the left upper quadrant in addition to the presence of stomach in the left thorax associated with mediastinal shift and right deviated heart. The fetal MRI didn’t show the left diaphragmatic dome, it showed the rise of stomach digestive handles and spleen occupying the left hemi-thorax. Was added by amniocentesis for karyotype study that normal income (46 XY).During the ultrasound monitoring, there was no polyhydramnios noted and transverse abdominal diameter was average. The evolution was marked by a premature birth by natural means to 33 SA a newborn male who presented immediate respiratory distress in the labor ward, died in H1 living child.

Case 2

morphological ultrasound done at 23 weeks of amenorrhea for a 30 year -old woman diagnosed a left diaphragmatic hernia isolated with no other associated malformations. We didn’t found chromosomal abnormalities. The delivery was programmed in collaboration with the pediatric surgeons, the child was operated but the outcome was unfavorable with the death of the child two months later.

Conclusion

Multiple ultrasound markers have been identified as items of diagnosis and predictive of outcome. Magnetic resonance imaging have been identified as additional imaging modalities that can assist in making the antenatal diagnosis and accurately assessing perinatal outcome.

Keywords

Sonography; antenatal diagnosis; congenital diaphragmatic hernia