X-ray signs of congenital diaphragmatic hernias in term newborns

BACKGROUND: Imaging plays a major role in the initial diagnosis, treatment, and subsequent assessment of congenital diaphragmatic hernias. Chest X-ray is still of great importance in newborns due to the availability and relative ease of use.

AIM: To reveal radiological signs determining congenital diaphragmatic hernias in term newborns.

METHODS: The study was conducted at the K. Faradzheva Research Institute of Pediatrics. The study group consisted of 7 term newborns with diaphragmatic hernias. All children underwent chest X-ray. The comparison group included 18 children without congenital anomalies of the respiratory system.

RESULTS: Congenital diaphragmatic hernias, which occur during intrauterine development, were found in term newborns in our study. Hernia of the diaphragmatic esophagus is more common in newborns. Hernia of the diaphragm is the second most frequent, while hernias of the anterior diaphragm in newborns are extremely rare. The bronchus was visualized in 50% of term newborns with diaphragmatic hernias (χ²=27.329; p <0.001). Impaired diaphragmatic integrity was visualized in all term patients with diaphragmatic hernias and in 20% of those with congenital anomalies (p <0.001). In the same patients, X-ray showed the stomach and/or intestinal loops in the thoracic cavity.

CONCLUSIONS: The radiological picture of a diaphragmatic hernia is characterized by a decreased lung volume, impaired visualization of the bronchi, impaired diaphragmatic integrity, impaired clarity of diaphragmatic contours, and the presence of stomach/intestinal loops in the thoracic cavity.