Abstract
Background
A hernia is due to a defect in the diaphragm. An eventration is due to a thinned diaphragm with no central muscle. Distinguishing right diaphragmatic hernia from eventration on chest radiographs can be challenging if no bowel loops are herniated above the diaphragm. Experience is limited with postnatal ultrasound (US) evaluation of diaphragmatic hernia or eventration.
Objective
To evaluate for specific US signs in the diagnosis of right diaphragmatic hernia and eventration.
Materials and methods
We identified all patients (January 2007–December 2017) with right diaphragm US and surgery for eventration or hernia. We reviewed medical charts, and US images/reports for clinical presentation and diaphragm abnormalities. Surgical diagnosis was considered the reference standard.
Results
Seventeen children (mean age: 5 months) had US examination before surgery for hernia (n=9) or eventration (n=8). The most common presentation was respiratory distress. In the US reports, hernia was correctly diagnosed in all patients and three patients with eventration were misdiagnosed as hernia, yielding 100% sensitivity and 62.5% specificity. In a retrospective evaluation of the US studies, a combination of folding of a free muscle edge with a narrow angle waist had 100% specificity for hernia and was seen in 7/9 children with hernia. Combination of a broad angle waist and hypoechoic strip of diaphragmatic muscle covering the waist had 100% specificity for eventration and was demonstrated in 4/8 children with eventration. Five of 17 patients (31.6%) had no specific sign that differentiated hernia from eventration.
Conclusion
On US, folding of the free edge of the diaphragm and a narrow angle waist are specific for hernia; a broad angle waist with muscle covering the elevated area is specific for eventration. Definitive differentiation between eventration and hernia may not be possible in about a third of patients.
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References
Partridge EA, Peranteau WH, Herkert L et al (2016) Right- versus left-sided congenital diaphragmatic hernia: a comparative outcomes analysis. J Pediatr Surg 51:900–902
Hedrick HL, Crombleholme TM, Flake AW et al (2004) Right congenital diaphragmatic hernia: prenatal assessment and outcome. J Pediatr Surg 39:319–323
Jani P, Bidarkar SS, Walker K et al (2014) Right-sided congenital diaphragmatic hernia: a tertiary centre’s experience over 25 years. J Neonatal-Perinatal Med 7:39–45
Losty PD (2014) Congenital diaphragmatic hernia: where and what is the evidence? Semin Pediatr Surg 23:278–282
Midrio P, Gobbi D, Baldo V, Gamba P (2007) Right congenital diaphragmatic hernia: an 18-year experience. J Pediatr Surg 42:517–521
Clifton MS, Wulkan ML (2017) Congenital diaphragmatic hernia and diaphragmatic eventration. Clin Perinatol 44:773–779
Chavhan GB, Babyn PS, Cohen RA, Langer JC (2010) Multimodality imaging of the pediatric diaphragm: anatomy and pathologic conditions. Radiographics 30:1797–1817
Datin-Dorriere V, Rouzies S, Taupin P et al (2008) Prenatal prognosis in isolated congenital diaphragmatic hernia. Am J Obstet Gynecol 198:80.e81–80.e85
Worley KC, Dashe JS, Barber RG et al (2009) Fetal magnetic resonance imaging in isolated diaphragmatic hernia: volume of herniated liver and neonatal outcome. Am J Obstet Gynecol 200:318.e311–318.e316
Alamo L, Gudinchet F, Meuli R (2015) Imaging findings in fetal diaphragmatic abnormalities. Pediatr Radiol 45:1887–1900
Schimpl G, Fotter R, Sauer H (1993) Congenital diaphragmatic hernia presenting after the newborn period. Eur J Pediatr 152:765–768
Comberiati P, Giacomello L, Camoglio FS, Peroni DG (2015) Diaphragmatic hernia in a pediatric emergency department. Pediatr Emerg Care 31:354–356
Eren S, Ciris F (2005) Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol 54:448–459
Taylor GA, Atalabi OM, Estroff JA (2009) Imaging of congenital diaphragmatic hernias. Pediatr Radiol 39:1–16
Gierada DS, Slone RM, Fleishman MJ (1998) Imaging evaluation of the diaphragm. Chest Surg Clin N Am 8:237–280
Hattori K, Takamizawa S, Miyake Y et al (2018) Preoperative sonographic evaluation of the defect size and the diaphragm rim in congenital diaphragmatic hernia - preliminary experience. Pediatr Radiol 48:1550–1555
El-Halaby H, Abdel-Hady H, Alsawah G et al (2016) Sonographic evaluation of diaphragmatic excursion and thickness in healthy infants and children. J Ultrasound Med 35:167–175
Gerscovich EO, Cronan M, McGahan JP et al (2001) Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 20:597–604
Wu S, Zang N, Zhu J et al (2015) Congenital diaphragmatic eventration in children: 12 years' experience with 177 cases in a single institution. J Pediatr Surg 50:1088–1092
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Karmazyn, B., Shold, A.J., Delaney, L.R. et al. Ultrasound evaluation of right diaphragmatic eventration and hernia. Pediatr Radiol 49, 1010–1017 (2019). https://doi.org/10.1007/s00247-019-04417-1
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DOI: https://doi.org/10.1007/s00247-019-04417-1