Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

QUIZ
Year
: 2002  |  Volume : 12  |  Issue : 3  |  Page : 437--438

Radiological quiz - chest


MB Popli, V Popli 
 Dept of Pediatrics, MAM College, Delhi, India

Correspondence Address:
M B Popli
127-B/Ac II, Shlimar Bagh, Delhi 110088
India




How to cite this article:
Popli M B, Popli V. Radiological quiz - chest.Indian J Radiol Imaging 2002;12:437-438


How to cite this URL:
Popli M B, Popli V. Radiological quiz - chest. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Sep 22 ];12:437-438
Available from: http://www.ijri.org/text.asp?2002/12/3/437/28505


Full Text

A four months old male child was admitted to our hospital with complaints of respiratory distress, fever and cough for past one week. Chest radiograph revealed obliteration of the right hemi diaphragmatic shadow, with haziness of middle and lower zones of right hemi thorax blending with the cardiac outline. Patient was given a full course of antibiotics, but was without much relief. A repeat X-ray chest showed no change [Figure 1]. Patient was sent for US and CT [Figure 2] and [Figure 3] for better delineation of pathology.

 View Answer

 Radiological Diagnosis



Congenital Diaphragmatic Hernia of the Liver

The differential diagnosis of the chest lesions is extensive and varied [1]. An infrequent cause in children is congenital diaphragmatic hernia (CDH), with herniation of the abdominal contents into the chest, especially into right hemi thorax. Congenital diaphragmatic hernia is one of the acute pediatric surgical emergencies and an important cause of perinatal mortality. Its incidence varies from 1:2000 to 1:5000 live births with a greater incidence in stillbirths and abortions. Non- operative mortality is generally reported as 100% and an early diagnosis is imperative [2]. CDH results because the pleuro-peritoneal canal fails to close at the end of the embryonic period i.e. 8-10 weeks of development, leading to a defect in the dorso-lateral region of the diaphragm [3]. As a result of this failure to close organs from the abdominal cavity are able to migrate and grow in the chest cavity thus preventing the lungs from fully developing. Some of the organs that are found in the chest include the stomach, intestine, liver, spleen, gall bladder, as well as occasionally even the kidneys and other organs. The three basic types of CDH are the posterolateral Bochdalek hernia, the anterior Morgagni hernia and the hiatus hernia. The left-sided Bochdalek hernia occurs in approximately 90% of cases. Left-sided hernias allow herniation of both small and large bowel as well as intra abdominal solid organs into the thoracic cavity. In less common right-sided hernias only the liver and a portion of the large bowel tends to herniate.

Diagnosis of CDH is easy on plain x-ray films if the contents of hernia are intestines, but if these are greater omentum or liver, discrimination from thoracic tumor is difficult. Ultrasound and CT are of assistance in identifying and defining the location of the liver in relationship to other structures [4],[5],[6]. Despite significant improvement in postnatal care of infants with CDH, mortality remains high. Ultrasound, antenatally can clinch the diagnosis and repair of CDH in utero can improve the outcome for these babies.

References

1Haden MJ, Bowen A. Bronchopulmonary and Neuroenteric forms of foregut anomalies. RCNA 1991;29: 241-254
2Pfleghaar KM, Wapner RJ, Kuhlman KA, Spitzer AR. Congenital diaphragmatic hernia: prognosis and prenatal detection. Fetal Diagn Ther 1995;10:393-9
3Harrison MR, Adzick NS, Flake AW. Congenital Diaphragmatic Hernia: an unsolved problem. Semin. Pediatric Surg. 1993; 2:109-12.
4Naganuma H, Ishida H, Niizawa M et al . Intrathoracic accessory lobe of the liver. J Clin Ultrasound 1993;21:143-6
5Hill MC, Lande IM, Larsen JW. Prenatal diagnosis of fetal anomalies using ultrasound and MRI. RCNA 1988;26:287-314
6Helen Yeo. Congenital Diaphragmatic Hernia: Lowering the mortality rates. Journal of Neonatal Nursing.1999 5;5: 6-9.