Ultrasonographic manifestations and diagnostic value of congenital diaphragmatic hernia in neonates

Objective To discuss ultrasound image features of neonatal congenital diaphragmatic hernia (CDH), and to improve the neonatal diagnosis of the disease by ultrasound. Methods There were 19 neonatal patients who were diagnosed as CDH by ultrasound from January 2000 to September 2017, and those diagnoses were confirmed by operation and pathology. The average age of patients were (12.8±11.7) days. Of them, 3 cases had been successfully diagnosed as diaphragmatic hernia in prenatal ultrasound. In clinical manifestations, 11 cases had dyspnea, 3 cases had vomiting and 2 cases had tachycardia. The ultrasonic images features of CDH were summarized. Results Nineteen cases of neonatal diaphragmatic hernia were diagnosed correctly by ultrasound. There were 16 cases of posterolateral hernia, 2 cases of esophageal hiatal hernia, and 1 case with difficulty in distinguishing between diaphragmatic hernia and eventration of the diaphragm. The diagnostic accuracy rate was 94.74% (18/19). There were herniated content were small intestine herniated to left thoracic cavity in 4 cases, stomach fundus in 2 cases, spleen herniated in 3 cases, left adrenal gland and upper pole of left renal in 1 case, small intestine from the abdominal cavity herniated to right thoracic cavity in 3 cases, part of right lobe liver with gallbladder herniated to thoracic cavity in 4 cases, and right adrenal gland and the right kidney in 2 cases. The herniated content of the esophageal hiatus hernia were stomach in all cases. Ultrasound image features of CDH of posterolateral hernia were discontinued diaphragm, through which the abdominal and retroperitoneal organs herniated into the chest cavity. Ultrasound image features of CDH of esophageal hiatus hernia were the herniation of gastrointestinal tract into the chest cavity through esophageal fissure. Conclusions Ultrasonic examination can clearly display the diaphragm in real time, and the diagnostic accuracy is comparable to that of CT and MR. As a non-radiative approach, ultrasound should be the first choice of imaging examination in diagnosing CDH for neonate. Key words: Ultrasonography; Neonatal; Congenital diaphragmatic hernia