← All decks
Radiology
Congenital Diaphragmatic Hernia
Built from Obstetric Imaging
What’s inside
12 sections · 95 slides
Overview
- What this deck covers
- The short version
A hole in the floor of the chest
What the defect is and why the lungs pay the price
- The diaphragm, in plain words
- When the floor does not close
- From a gap in the muscle to a baby who cannot breathe
- What the crowded lung is missing
- What goes wrong the moment the cord is cut
- Where the gap sits
- Naming the defect by its position
- 1:2500
How common, which side, what else
Epidemiology, associated anomalies and honest survival figures
- How often it happens
- Which side the hernia is on
- Alone, or part of something bigger
- What happens to these pregnancies
- Why a quoted survival rate can mislead
- The other half of the assessment
- Structural anomalies most often found with congenital diaphragmatic hernia
- Why the genetics matter here
- Genetic anomalies most often found with congenital diaphragmatic hernia
- Genetic anomalies most often found with congenital diaphragmatic hernia (continued)
- Genetic anomalies most often found with congenital diaphragmatic hernia (continued)
- Genetic anomalies most often found with congenital diaphragmatic hernia (continued)
- Genetic anomalies most often found with congenital diaphragmatic hernia (continued)
Why it happens
How the diaphragm is built, and what the lung tissue looks like
- Four pieces that fuse into one dome
- Building the diaphragm, and how it fails
- What the small lung looks like under a microscope
- Squeezed, or sick from the start?
How the diagnosis is made
Incidental on a scan, or a struggling newborn
- How it usually comes to light
- How often the scan misses it
- The newborn nobody was expecting
- Why finding it early changes everything
What it looks like on ultrasound
Direct signs, side-by-side differences, and indirect clues
- The first clue on the scan
- A left-sided hernia on the scan
- Left-sided hernia with liver, stomach and bowel in the chest
- Signs that the liver has moved up
- A right-sided hernia on the scan
- Right-sided hernia with liver in the chest and a small pleural effusion
- Left versus right at a glance
- When both sides are open
- Bilateral hernia on ultrasound and MRI
- Traced lung outlines on MRI in bilateral disease
- Clues you can see without seeing the hernia
- The prenatal work-up, in order
- Step one: rule out everything else
Measuring the lungs
The lung-to-head ratio, why it needed fixing, and what it predicts
- Why lung size is the number that matters
- How the lung-to-head ratio is taken
- Tracing the lung to work out its area
- Easy to describe, hard to do
- Why the raw ratio does not work
- Observed over expected: the fix
- Lung size plus liver position
- Survival against lung size, split by liver position
- Reading that survival graph
- Stomach position as a stand-in
- The blind spot: the lung blood vessels
What MRI adds
Why fetal lung shows up so well, and where the limits are
- Why MRI shows fetal lung so well
- Stomach and bowel in the left chest on fetal MRI
- The sequences used, and why
- What MRI adds, and what it does not
What else it could be
Chest lesions that mimic it, and the sign that separates them
- Other things that fill a fetal chest
- The one sign that settles most of it
- Eventration: the tricky one
Treatment before birth
Tracheal occlusion: the idea, the technique, and the trial results
- Why anyone would operate before birth
- The approach that failed
- The idea behind blocking the windpipe
- From an open clip to a balloon in the airway
- How the balloon is placed
- Placing an endoluminal balloon in the fetal trachea
- Balloon deployment inside the trachea, step by step
- Timing, and getting the balloon out
- The trial in severe hypoplasia
- The trial in moderate hypoplasia
- Right-sided disease
- What pooling the data showed
- Outcomes of isolated CDH: expectant management versus tracheal occlusion
- The price of the procedure
- Where the debate stands
Care after birth
Where to deliver, how to ventilate, when to operate
- Where the baby must be born
- The first hours
- Gentle ventilation
- When ventilation is not enough
- Treating the high lung pressure
- Repairing the diaphragm
- Life after discharge
Bringing it together
What to remember and what to tell the referring doctor
- What the referring doctor needs to know
- Key points
- Key points, continued
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition