Diagnostic ultrasound ( PDFDrive )

1260 PART IV Obstetric and Fetal Sonography
Li
A Left
Right
B
C
1
D
E
F
C
G
H
I
FIG. 36.13 Left-Sided Congenital Diaphragmatic Hernia. (A) Axial view of chest at 28 weeks’ gestation shows the stomach (arrow) in the
chest with mediastinal shift to the right. (B) Coronal image in a different fetus at 28 weeks shows a slightly distended stomach (arrow) in the
chest. (C) Oblique sagittal image shows a large amount of liver (Li) in the chest. Note the hepatic vessels (arrows). (D) Axial view of abdomen
shows abnormal course of umbilical vein (arrowhead) resulting from the liver herniation into the chest. (E) Oblique axial view of chest shows kinked
hepatic vessels. (F) Axial view in the right lower quadrant shows the associated polyhydramnios complicating the pregnancy in the same fetus.
(G) Sagittal T2-weighted fetal MRI shows the small bowel (arrow) and colon (arrowhead) in chest with small pleural effusion. (H) Sagittal T1-weighted
fetal MRI shows liver (arrow) in chest. Note bright signal of meconium in colon (C) in chest, as well as small bowel loops (arrowhead) in chest. (I)
Postnatal radiograph shows the bowel in the left chest, nasogastric tube in the left chest, and a tiny, hypoplastic right lung. See also Videos 36.3,
36.4, and 36.5.
of CPAM. 185-187 MRI can reveal the location of bowel because
of the bright T1 signal of meconium. If the superior aspect of
herniated bowel is rounded with trapped luid below, a hernia
sac can be suggested. hese membrane-covered hernias are
associated with a better prognosis. 185 MRI is also useful for
the visualization of the normal ipsilateral and contralateral
lung, allowing for the measurement of lung volumes useful
for predicting outcome. 188 MRI measurements include total
lung volume, observed-to-expected total fetal lung volume
(o/e TFLV), percent predicted lung volume (PPLV), fetal