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 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