Fetal magnetic resonance imaging of congenital diaphragmatic hernia

Objective 

Fetal magnetic resonance (MR) imaging plays a number of roles in the evaluation and management of congenital diaphragmatic hernia (CDH). Fetal MR imaging has proved valuable for anatomic assessment, determination of the specific type of CDH on the basis of which organs are involved and the effect of the hernia contents on adjacent structures, evaluation and exclusion of hernia-related complications and associated malformations. In addition, fetal MR imaging plays a role in guiding experimental fetal therapy (eg, tracheal balloon occlusion).

Method 

We present a case of CDH that was diagnosed in the 30 week of pregnancy by two-dimensional ultrasonography (USG) in association with fetal MR.

Case 

A 31-year-old nulliparous woman with unremarkable past medical history and no significant prenatal risk factor was referred to our department at 30 weeks’ gestation for detailed ultrasound examination, which revealed a fluid-filled structure in the thoracic cavity. Ultrasonographic examination showed a fluid-filled stomach and intestinal peristalsis in the left thorax with the heart displaced to the right in the axial scan. Fetal MR confirmed the ultrasonographic findings, and herniated organs and mediastinal shift were clearly visible. There was no associated anomaly in central nervous system, heart, both kidneys and extremities in ultrasonography. The couple was informed of the diagnosis and patient was followed-up fortnightly. At 36 weeks of gestation, planned cesarean section was performed. The newborn girl had signs of severe respiratory distress and required extracorporeal membrane oxygenation support. The CDH was successfully repaired at 3 days of life. Surgical results confirmed the prenatal diagnosis.

Conclusion

Prenatal sonographic detection of this rare anomaly may allow planned delivery at a tertiary center and early correction. Prenatal MR imaging can confirm the diagnosis of a CDH when sonographic findings are equivocal or atypical.

Keywords

Fetal MR, congenital diaphragmatic hernia, prenatal diagnosis.