ultrasound diagnosis of fatal anomalies

THORAX
Fig. 4.15 Left-sided diaphragmatic hernia. The
same case viewed longitudinally. The diaphragm is
seen ventrally but not dorsally. The intestine is seen
continuously up into the thorax.
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Prognosis: The prognosis depends on the severity
of respiratory distress, especially hypoplasia
of the lung and other concomitant anomalies.
The earlier the diagnosis is made in prenatal
screening, the poorer the prognosis (15–50%
mortality). The prognosis worsens if the diagnosis
is made prior to 24 weeks’ gestation and hydramnios
develops. Mortality is influenced by
the neonatologist’s experience and possibly also
concurrent the use of extracorporeal membrane
oxygenation (ECMO). The value of intrauterine
prognostic factors for determining the extent of
hypoplasia of the lungs (area of the lung, Doppler
sonography of the pulmonary artery, and
amniotic flow in the trachea) is uncertain. Intrauterine
fetal surgery (e.g., tracheal blockage)
is still in the experimental phase. Neonates who
can be stabilized postnatally prior to surgery
have about a 65–85% chance of survival. Some
children develop a chronic respiratory distress
syndrome.
Self-Help Organization
Title: CHERUBS Association for Congenital Diaphragmatic
Hernia Research, Advocacy, and
Support
Description: Support and information to
families of children born with congenital diaphragmatic
hernias. Phone support, online
services, on-call volunteers, state and country
representatives, pen pals, medical research,
information and referrals, newsletter.
Scope: International network
Founded: 1995
Address: P.O. Box1150, Creedmoor, NC 27565,
United States
Telephone: 1–888–834–8158 or 919–693–
8158
Fax: 707–924–1114
E-mail: info @cherubs-cdh.org
Web: http://www.cherubs-cdh.org
References
Adzick NS, Vacanti JP, Lillehei CW, O’Rourke PP, Crone
RK, Wilson JM. Fetal diaphragmatic hernia: ultrasound
diagnosis and clinical outcome in 38 cases. J
Pediatr Surg 1989; 24: 654–7.
Albanese CT, Lopoo J, Goldstein RB, et al. Fetal liver position
and perinatal outcome for congenital diaphragmatic
hernia. Prenat Diagn 1998; 18: 1138–42.
Al-Shanafey S, Giacomantonio M, Henteleff H. Congenital
diaphragmatic hernia: experience without extracorporeal
membrane oxygenation. Pediatr Surg Int
2002; 18: 28–31.
Kalache KD, Chaoui R, Hartung J, Wernecke KD,
Bollmann R. Doppler assessment of tracheal fluid
flow during fetal breathing movements in cases of
congenital diaphragmatic hernia. Ultrasound Obstet
Gynecol 1998; 12: 27–32.
Kasales CJ, Coulson CC, Meilstrup JW, Ambrose A, Botti
JJ, Holley GP. Diagnosis and differentiation of congenital
diaphragmatic hernia from other noncardiac
thoracic fetal masses. Am J Perinatol 1998; 15: 623–
8.
Lewis DA, Reickert C, Bowerman R, Hirschl RB. Prenatal
ultrasonography frequently fails to diagnose congenital
diaphragmatic hernia. J Pediatr Surg 1997;
32: 352–6.
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