Presentation is loading. Please wait.

Presentation is loading. Please wait.

Congenital Diaphragmatic Hernia & Eventration Of Diaphragm

Similar presentations

Presentation on theme: "Congenital Diaphragmatic Hernia & Eventration Of Diaphragm"— Presentation transcript:

1 Congenital Diaphragmatic Hernia & Eventration Of Diaphragm

2 Development of diaphragm
Tissues of origin Septum transversum Esophageal mesentry Mesoderm from body wall Lumbar somites

3 Development of diaphragm

4 Pathology of CDH Failure of closure of pleuro-peritoneal canal
Most common area is a postero-lateral defect ( Bochdalek ) Left side more common

5 Pathology of CDH Diaphragmatic defect
Abdominal viscera fill the chest cavity Abdomen small & poorly developed

6 Pathology of CDH Both lungs hypoplastic
More so on the ipsilateral side Pulmonary vessels hypoplastic PPHN

7 Pathology of CDH Following delivery Bowels fill with air
Compression of ipsilateral lung Mediastinal shift Compression of contralateral lung mechanical compression of lung

8 Pathology of CDH Respiratory distress Lung hypoplasia
PPHN Mechanical compression Respiratory distress

9 Lung development in CDH
No. of bronchial branches – greatly reduced Alveolar development severely affected Increased muscle mass in the conducting airways Seen in contra lateral lung too

10 Pulmonary vasculature in CDH
Reduction in the total no. of branches Both in ipsilateral and contra lateral lungs Significant adventitial and medial wall thickening Increased susceptibility to PPH hypoxia, acidosis, hypothermia, stress



13 Persistent fetal circulation
pulmonary artery resistance pressures vascular flow Right to left shunting Hypoxia & Progressive desaturation Respiratory failure

14 Diagnosis CXR diagnostic Absence of diaphragm Scaphoid abdomen
Bowel loops in chest Mediastinal shift

15 Chest X - Ray

16 Problems Hypoxia Respiratory distress Metabolic acidosis Hypercarbia


18 Treatment Initial goal Stabilisation of respiration Treatment of PPHN

19 Treatment Oxygenation & mechanical ventilation
Correction of PPHN (NO / Vasodilators ) Correction of metabolic acidosis

20 Treatment Surgical repair of the defect Abdominal approach
Post-op ventilation


22 Newer advances in therapy
In utero repair PLUG therapy ECMO

23 Prenatal diagnosis USG @ 16 weeks Herniated viscera in the chest
Mediastinal shift to opposite side Stomach in the chest Associated anomalies 40%

24 Hernia of Morgagni Antero-medial defect Para-esophageal
Lucencies in mediastinum Respiratory distress Surgical correction

25 Eventration of diaphragm

26 Pathology Attenuation of central muscular portion of diaphragm
Phrenic nerve damage Idiopathic ( birth injury )

27 Clinical presentation
Similar to CDH Respiratory birth Recurrent respiratory tract infections in infancy

28 Chest X - Ray Elevated thinned out diaphragm Bowel loops in chest
Mediastinal shift

29 Chest X - Ray

30 Treatment Surgical repair of the defect Abdominal approach

Download ppt "Congenital Diaphragmatic Hernia & Eventration Of Diaphragm"

Similar presentations

Ads by Google