Congenital diaphragmatic hernia - right-sided

Most diaphragmatic hernias (90%) are left-sided, whilethus right-sided are encountered inaccount for only 10% of the cases. Diagnosis of left-sided is usually easier thanks to the stomach acting as an acoustic window. US contrast resolution is often confusing to depictresults in difficulties in distinguishing lung from liver in standard screening, hence small right-sided diaphragmatic hernias may be missed.MR imaging depicts a clearer image of the anatomy, thanks to its multiplanar analysis and improved contrast. LikeIn fetal US the lung to head ratio is employed, whilst with Lung To Head Ratio, MR provides additional prognosisprognostic factors with Estimated Fetal Lung Volume assessementestimated fetal lung volume assessment, which is compared to normal fetal lung volume expected for gestationnalgestational age.Right-sided hernia may be part of a syndromic condition such as wider pathology, e.g. Fryns syndrome (Omim #229850), which includes additional facefacial and limbslimb anomalies. This; this is not the case here.

Thoracic and abdominal situs concords, with both heart and stomach on the left side.US assessment of cardiac anatomy is difficult due to poor acoustic window within this patient.Cardiac axis looks normal, but heart position is shifted to the left: this situation suggests absence of a left-sided structure or a compressive right-sided structure.Color dopplerDoppler shows on the right side a vessel which was wellcould be clearly followed from the umbilical cord, compatible with a portal vein sinus. Suspicion of liver ascension within a normal sized-thorax: right diaphragmatic hernia?

MR allows better visualization of lung and liver: lung's signal is hyperT2whyper T2W while liver's signal is hypoT2whypo T2W.MR confirms the right sided-sided diaphragmatic defect with an intrathoracic liver within thorax. Portal vein sinus is seen in the coronal and axial planeplanes as a tubular structure without signal due to flow-voids.Right lung is not seen.Left lung is shrunkatrophic. Pulmonary volumetry 7mL7 mL, while expected volumetry for gestationnalgestational age is around 40mL~40 mL.

T1 sequence allows meconium identification: hence the colon is found here in the right abdominal upper quadrant. Note that liver is slightly hyperT1hyper T1W compared to lung as well.