Presentation
Newborn term baby. Oxygen requirement.
Patient Data
ET tube tip appropriate. NG tube tip short.
Increased lucency in the left lower chest. Contralateral mediastinal shift. No clear diaphragm. Appearances concerning for left sided congenital diaphragmatic hernia.
Umbilical lines have been inserted - UAC position appropriate. NG tube remains short.
Aeration of stomach and small bowel clearly demonstrate them in the thoracic cavity. Confirms congenital diaphragmatic hernia.
The NG tube has been advanced. Tube tip in stomach in left lower chest. UVC tip in right atrium and should be pulled back.
Post-operative appearances. A collapsed lung and gas-filled pleural space are normal in the post-operative period. Pulmonary hypoplasia is one of the main side-effects of CDH and the lung will probably not expand to fill the hemithorax.
Case Discussion
Series of appearances of congenital diaphragmatic hernia. Early appearances before bowel gas is present may be challenging. Left basal abnormality with non-specific lucency and poor diaphragmatic contour should alter the reporter. There will usually be an antenatal history. The post-operative appearances are variable based on the size of the defect, what herniated and the degree of pulmonary hypoplasia.
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