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HERNIA THROUGH OESOPHAGEAL
HIATUS IN FETUS – A RARE
CAUSE OF CONGENITAL
DIAPHRAGMATIC HERNIA
Dr Irfan A. Kazi MD[RD]
Radio...
Introduction
 Congenital diaphragmatic hernia [CDH] is a
herniation of abdominal contents into chest cavity. It
can be th...
Clinical presentation
 A 25 yr old 2nd gravida, with one normal child aged 2yrs, came to our clinic for TIFFA
at 21wks of...
Coronal view of thorax and abdomen
Superior
Left
Right
Coronal view of thorax and abdomen
Superior
Left
Right
In the coron...
ant
left
stomach stomach
ant
right
Heart
The image above shows a hernia
through the oesophagial hiatus in which
the heart ...
Discussion
Left sided hernia
 Four classic findings
 Cystic mass on left side of chest
 Absence of fluid filled stomach...
DD for CDH
Other cystic masses
 Bronchogenic cyst
 Oesophageal duplication cyst
 Neurenteric cyst
-All Are rare
-more o...
Prognosis
 65% survival if isolated
 Poor prognostic factors:
 Other abnormalities
 Liver in chest
 Large size
 Righ...
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Hernia through oesophageal hiatus in fetus. IRFAN KAZI. Ultrafest 2014

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Hernia through oesophageal hiatus in fetus. IRFAN KAZI. Ultrafest 2014

  1. 1. HERNIA THROUGH OESOPHAGEAL HIATUS IN FETUS – A RARE CAUSE OF CONGENITAL DIAPHRAGMATIC HERNIA Dr Irfan A. Kazi MD[RD] Radiologist, Sonosquare Ultrasound Clinic, Hyderabad
  2. 2. Introduction  Congenital diaphragmatic hernia [CDH] is a herniation of abdominal contents into chest cavity. It can be through  Foramen of Bochdalek-posterior diaphragmatic defect  Foramen of Morgagni-anterior diaphragmatic defect  Uncommonly, herniation through oesophageal hiatus or due to diaphragmatic agenesis
  3. 3. Clinical presentation  A 25 yr old 2nd gravida, with one normal child aged 2yrs, came to our clinic for TIFFA at 21wks of gestation  On USG, the fetal cardiac axis was abnormal & the fetal heart was displaced to the extreme left of the thorax.  The entire stomach was herniating into the thorax through a postero-medial diaphragmatic defect on the left of midline thereby displacing the heart.  These features were suggestive of diaphragmatic hernia, through the oesophageal hiatus.  Both the lungs were mildly compressed.  Right lung area : head circumference ratio(LHR) was 2.1  Heart was structurally normal  There was no pericardial or pleural effusion  Liver and portal veins were seen in the abdomen on the right side  No other obvious abnormalities were seen. The liquor was normal
  4. 4. Coronal view of thorax and abdomen Superior Left Right Coronal view of thorax and abdomen Superior Left Right In the coronal images, the stomach is seen in the midline, the heart on the left and the liver is seen in the abdomen. The ductus venosus is splayed to the left of midline as the heart is displaced to extreme left HEA-Heart St-Stomach DV- Ductus venosus D-Diaphragm RL- Right lung LIV- Liver
  5. 5. ant left stomach stomach ant right Heart The image above shows a hernia through the oesophagial hiatus in which the heart is displaced to the extreme left The image above shows a CDH through the left diaphragm (Bochdalek’s Hernia) in which the heart is displaced towards the right side
  6. 6. Discussion Left sided hernia  Four classic findings  Cystic mass on left side of chest  Absence of fluid filled stomach  Deviation of heart towards right  Polyhydramnios  Upto 85 % contain herniated liver Right sided hernia  Contains liver and bowel(doppler shows portal veins)  Stomach is below diaphragm (may be more in the midline)  Gall bladder may also be herniated Bilateral  Stomach is in the chest with no mediastinal shift  Colour doppler will show liver with portal veins on doppler Hernia through oesophageal hiatus  Stomach is in the midline in the thorax  Heart is deviated to the extreme left- helps diffferentiate from left sided hernia  The liver is seen in the abdomen- helps differentiate from right sided hernia
  7. 7. DD for CDH Other cystic masses  Bronchogenic cyst  Oesophageal duplication cyst  Neurenteric cyst -All Are rare -more often associated with mediastinum than lung CCAM  If it is of macrocystic type  diaphragm is intact  Stomach is below diaphragm  Doppler shows pulmonary arterial vascular supply Hybrid lesion  Combination of CCAM & sequestration  To be considered when cystic mass is fed by systemic vessel Teratoma  Solid & cystic components  Calcifications are seen
  8. 8. Prognosis  65% survival if isolated  Poor prognostic factors:  Other abnormalities  Liver in chest  Large size  Right sided/bilateral  LHR<1.0 LHR [lung:head ratio]  Area of contralateral lung/head circumference  Lung area is calculated by multiplying 2 orthogonal cross sectional lung measurements taken at the level of 4 chamber view  LHR<1.0 poor prognosis  >1.4good prognosis  Nowadays 3D softwares are available in USG & MRI which are better indicators of lung volume than LHR Treatment  Indications for intrauterine treatment:  Herniation of liver  LHR<1.0  Intrauterine intervention-  PLUG-plug lung until it grows  FETO-fetoscopic tracheal occlusion  Delivery by caesarean using ex-utero intrapartum treatment[ EXIT] if intrauterine intervention is done

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