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Ultrasound in Obstetrics & Gynecology :... Apr 2007To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis... (Review)
Review
Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia.
OBJECTIVES
To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia.
METHODS
We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies).
RESULTS
A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02).
CONCLUSIONS
The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.
Topics: Adult; Diagnosis, Differential; Diaphragmatic Eventration; Female; Fetal Diseases; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Pericardial Effusion; Pleural Effusion; Pregnancy; Ultrasonography, Prenatal
PubMed: 17366518
DOI: 10.1002/uog.3958 -
Canadian Medical Association Journal Jun 1949
Topics: Diaphragm; Hernia, Diaphragmatic; Hernia, Hiatal; Humans
PubMed: 18134627
DOI: No ID Found -
Annals of Surgery Jun 1990In the past 4 years at the Medical College of Georgia, a total of 74 patients underwent extracorporeal membrane oxygenation (ECMO) with 62 (84%) survivors. Forty-seven... (Comparative Study)
Comparative Study
In the past 4 years at the Medical College of Georgia, a total of 74 patients underwent extracorporeal membrane oxygenation (ECMO) with 62 (84%) survivors. Forty-seven of these infants had meconium aspiration syndrome and 11 had diaphragmatic hernia. The use of ECMO, when indicated, after reduction and repair of the diaphragmatic hernia, results in normal oxygen delivery, allows time for pulmonary maturation, and increases survival. A total of 27 referrals for diaphragmatic hernia were studied. Six infants had surgical repair and did not require ECMO. Eleven patients, after surgical repair, were treated with ECMO and seven survived. More importantly 10 patients died before the use of ECMO. Six infants died either before or during transport from referring hospitals and four died while in the delivery room or neonatal unit before ECMO. Of these 10 infants, eight were potential candidates for ECMO. Thirteen of the twenty-seven (48%) infants survived. Seven of eleven (64%) infants who received the benefit of ECMO survived. Eight infants who met the criteria for ECMO died before its use. Had ECMO been used in those eight infants, our data suggests that at least four may have survived. The data from this report support the concept that infants undergoing surgical repair of diaphragmatic hernia, when ECMO is not available, should be referred to an ECMO center in the early postoperative period. Furthermore infants with prenatal diagnosis of diaphragmatic hernia should be delivered at a center where surgical as well as ECMO expertise are available.
Topics: Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant; Infant, Newborn; Referral and Consultation; Survival Rate; Time Factors
PubMed: 2357142
DOI: No ID Found -
Pediatrics and Neonatology Apr 2010
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans
PubMed: 20417457
DOI: 10.1016/S1875-9572(10)60015-0 -
Annals of Surgery Nov 1992Availability of extracorporeal membrane oxygenation (ECMO) support and the potential advantages of delayed repair of congenital diaphragmatic hernia (CDH) have led...
Availability of extracorporeal membrane oxygenation (ECMO) support and the potential advantages of delayed repair of congenital diaphragmatic hernia (CDH) have led several centers to delay CDH repair, using ECMO support if necessary. This study reviews the combined experience of five ECMO centers with infants who underwent stabilization with ECMO and repair of CDH while still on ECMO. All infants were symptomatic at birth, with a mean arterial oxygen pressure (PaO2) of 34 mmHg on institution of bypass despite maximal ventilatory support. A total of 42 infants were repaired on ECMO, with 18 (43%) surviving. Seven infants had total absence of the diaphragm, and 28 required a prosthetic patch to close the defect. Only five infants ever achieved a best postductal PaO2 over 100 mmHg before institution of ECMO. Prematurity was a significant risk factor, with no infants younger than 37 weeks of age surviving. Significant hemorrhage on bypass was also a hallmark of a poor outcome, with 10 of the 24 nonsurvivors requiring five thoracotomies and six laparotomies to control bleeding, whereas only one survivor required a thoracotomy to control bleeding. In follow-up, nine of the 18 survivors (50%) have developed recurrent herniation and seven (43%) have significant gastroesophageal reflux. Importantly, five of the 18 survivors were in the extremely high-risk group who never achieved a PaO2 over 100 mmHg or an arterial carbon dioxide pressure (PaCO2) less than 40 mmHg before the institution of ECMO. In conclusion, preoperative stabilization with ECMO and repair on bypass may allow some high-risk infants to survive. Surviving infants will require long-term follow-up because many will require secondary operations.
Topics: Extracorporeal Membrane Oxygenation; Follow-Up Studies; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Postoperative Complications; Retrospective Studies; Risk Factors; Survival Rate
PubMed: 1444648
DOI: 10.1097/00000658-199211000-00008 -
Annals of Surgery Jun 1962
Topics: Diaphragm; Hernia; Hernia, Diaphragmatic; Hernia, Hiatal; Humans
PubMed: 14037271
DOI: 10.1097/00000658-196215560-00016 -
Ultrasound in Obstetrics & Gynecology :... Dec 2009To prospectively determine apparent diffusion coefficient (ADC) values of normally developing fetal lungs over gestation, as obtained by diffusion-weighted (DW) magnetic...
OBJECTIVE
To prospectively determine apparent diffusion coefficient (ADC) values of normally developing fetal lungs over gestation, as obtained by diffusion-weighted (DW) magnetic resonance imaging (MRI) and to investigate its potential application in fetuses with congenital diaphragmatic hernia (CDH).
METHODS
Informed consent was obtained for this cross-sectional study of 93 fetuses with normal lungs and 14 with isolated left-sided CDH, assessed between 18 and 40 weeks of gestation. MRI delineation of left and right lungs was performed on the native DW image, b0, and three values of ADC, corresponding to the overall value (ADC(avg)), and values for low and high values of b (ADC(low) and ADC(high), respectively) were calculated. Regression analysis was used to assess the relationship between gestational age and b0-values as well as calculated ADC values. The b0 and ADC values of normal and CDH fetuses were compared with normal ranges using the Mann-Whitney U-test.
RESULTS
In fetuses with normal lungs, there was a negative correlation between gestational age and b0 values as well as with ADC(high), a positive correlation with ADC(low) but no correlation with ADC(avg). When measurable, ADC(high) values were lower in CDH as compared to fetuses with normal lungs and ADC(low) values were higher. ADC(low) was unrelated to lung volume.
CONCLUSIONS
There is a significant relationship between ADC(low) and ADC(high) values and gestational age in normal fetal lungs. This relationship is most probably explained by developmental changes during the last three stages of lung development, which involve intense peripheral growth of airways and vessels as well as maturation. In CDH, measurement of ADC(low) might be useful as a predictor of postnatal outcome that is independent of lung volume.
Topics: Cross-Sectional Studies; Diffusion Magnetic Resonance Imaging; Female; Fetal Development; Gestational Age; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Lung; Pregnancy; Statistics, Nonparametric
PubMed: 19866446
DOI: 10.1002/uog.7326 -
Journal of Pediatric Surgery Jan 2012We developed the congenital diaphragmatic hernia congenital prognostic index (CDH-CPI) to incorporate all known prognostic variables into a single composite index to...
PURPOSE
We developed the congenital diaphragmatic hernia congenital prognostic index (CDH-CPI) to incorporate all known prognostic variables into a single composite index to improve prognostic accuracy. The purpose of this study is to examine the ability of the CDH-CPI to predict survival in patients with left-sided congenital diaphragmatic hernia and to determine if the index has a stronger correlation with survival than each of the individual components.
METHODS
A retrospective review of patients with left-sided congenital diaphragmatic hernia between 2004 and 2010 was conducted. Ten prenatal parameters of the CDH-CPI were collected, total score was tabulated, and patients stratified according to total score and survival.
RESULTS
Sixty-four patients with a prenatal diagnosis of left-sided congenital diaphragmatic hernia were identified. Patients with a CDH-CPI score of 8 or higher had a significantly higher survival than patients with a CDH-CPI score of lower than 8. The CDH-CPI has the strongest correlation with survival compared with the individual parameters measured. The CDH-CPI correlates with extracorporeal membrane oxygenation use, and 75% of patients with a score of 5 or lower were placed on extracorporeal membrane oxygenation.
CONCLUSIONS
The CDH-CPI accurately stratifies survival in left-sided congenital diaphragmatic hernia. The amalgamation of 10 prenatal parameters of the CDH-CPI may be a better prenatal predictor than any single prognostic variable currently used.
Topics: Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Prognosis; Retrospective Studies; Severity of Illness Index; Survival Rate
PubMed: 22244393
DOI: 10.1016/j.jpedsurg.2011.10.020 -
Journal of the American Veterinary... Jan 2019
Topics: Animals; Arrhythmias, Cardiac; Cat Diseases; Cats; Diagnosis, Differential; Electrocardiography; Hernia, Diaphragmatic; Lethargy; Male
PubMed: 30668297
DOI: 10.2460/javma.254.1.71 -
BMJ Case Reports Mar 2019
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Gallstones; Hernia, Diaphragmatic; Humans; Male; Middle Aged; Thorax
PubMed: 30898946
DOI: 10.1136/bcr-2019-229286