Congenital Diaphragmatic Hernia

CDH is the herniation of the abdominal contents into the chest through a congenital defect in the diaphragm compressing the developing lung

Incidence: 1-4.5/10000 live births. Both male & female equally affected

Pathogenesis: Failure of pleuroparietal canals to close at the end of organogenesis. Diagnosed by 14 menstrual weeks: Left sided hernia is the commonest Bilateral CDH is rare.

Associated anomalies: Seen in 15-45%, Chromosomal abnormalities seen in 5- 15% most commonly Trisomy 18. Concomitant malformations include Cardiac & CNS abnormalities

Diagnosis: There is a Cardiomediastinal shift evident on 4 chamber view of the heart There is herniation of stomach intestines, liver or spleen into the chest. In Left sided CDH fluid filled fetal stomach is commonly seen in the chest in right sided CDH right lobe of liver is seen in the chest.

Prognosis: Isolated CDH is associated with survival rates of 50 – 60% large size. Early age at diagnosis (<24 wks) intrathoracic liver, small contralateral lung. Associated abdomalities & bilateral CDH are poor prognostic factors. Lung/head ratio (LHR) between 24-26 wks > 1.4 is associated with 100% survival & LHR < 1 is associated with 100% morality is associated with chromosomal anomalies prognosis is poor Bilateral CDH is always fetal.