1 / 30

Congenital Diaphragmatic Hernia & Eventration Of Diaphragm

Congenital Diaphragmatic Hernia & Eventration Of Diaphragm. Dr.V.N.Mahalakshmi. Development of diaphragm. Tissues of origin Septum transversum Esophageal mesentry Mesoderm from body wall Lumbar somites. Development of diaphragm. Pathology of CDH.

moesha
Download Presentation

Congenital Diaphragmatic Hernia & Eventration Of Diaphragm

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Congenital Diaphragmatic Hernia & Eventration Of Diaphragm Dr.V.N.Mahalakshmi

  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 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

  11. Persistent fetal circulation Respiratory failure

  12. Diagnosis • CXR diagnostic • Absence of diaphragm • Scaphoid abdomen • Bowel loops in chest • Mediastinal shift

  13. Chest X - Ray

  14. Problems Hypoxia Respiratory distress Metabolic acidosis Hypercarbia

  15. Treatment Initial goal • Stabilisation of respiration • Treatment of PPHN

  16. Treatment • Oxygenation & mechanical ventilation • Correction of PPHN (NO / Vasodilators ) • Correction of metabolic acidosis

  17. Treatment • Surgical repair of the defect • Abdominal approach • Post-op ventilation

  18. Newer advances in therapy • In utero repair • PLUG therapy • ECMO

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

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

  21. Eventration of diaphragm

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

  23. Clinical presentation Similar to CDH • Respiratory distress @ birth • Recurrent respiratory tract infections in infancy

  24. Chest X - Ray • Elevated thinned out diaphragm • Bowel loops in chest • Mediastinal shift

  25. Chest X - Ray

  26. Treatment • Surgical repair of the defect • Abdominal approach

More Related