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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Etiology/Pathophysiology:
Due to a congenital failure of the diaphragm to close correctly. The
most common diaphragmatic hernia in the newborn is Bochdalek which is
posterolateral in location and five times more common on the left
than on the right due to the presence of the liver on the right. The
degree of ipsilateral pulmonary hypoplasia is based on the size of
the hernia and what developmental stage it occurred at in utero and
interrupted pulmonary growth. Cases with large hernias can also have
contralateral pulmonary hypoplasia.
Persistent fetal circulation and pulmonary
hypertension can be complications of this arrested pulmonary
development.
Pathology:
Distinct abnormal openings in the diaphragm are seen at surgery.
Imaging Findings:
Herniated bowel (stomach, small bowel, colon) and solid viscera
(liver, omentum, spleen) are seen in the ipsilateral hemithorax
causing mediastinal shift. If seen immediately after birth, the
hemithorax may be opaque, until the bowel fills with gas
. Confirmation that the cystic lucencies
in the chest represent air in bowel can be made via insertion of a
nasogastric tube into the stomach to define its position, or via an
upper GI exam
. The Bochdalek hernia is five times more
common on the left
than on the right due to the presence of the liver
on the right
. Once repaired, the ipsilateral and contralateral
pulmonary hypoplasia is well seen, as the lungs often are too small
to expand to completely fill their hemithoraces.
DDX:
References
Additional pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com
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