Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia

Jeanty, Cerine; Nien, Jyh Kae; Espinoza, Jimmy; Kusanovic, Juan Pedro; Gonçalves, Luís F.; Qureshi, Faisal; Jacques, Suzanne M.; Lee, W.; Romero, R.

doi:10.1002/uog.3958

Cited by 27 publications

(12 citation statements)

References 114 publications

(199 reference statements)

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“…Finally, intrafetal fluid effusions are a relatively common ultrasound finding in CDH fetuses, observed in up to 5% and 29% of left‐ and right‐sided CDH cases, respectively . Such effusions could be related to liver congestion due to hepatic venous kinking, or to bowel irritation . However, it has been shown that CDH fetuses with associated pleural effusion/ascites have the same postnatal outcome as those with isolated CDH without those effusions .…”

Section: Additional Testingmentioning

confidence: 99%

Proposal for standardized prenatal ultrasound assessment of the fetus with congenital diaphragmatic hernia by the European reference network on rare inherited and congenital anomalies (ERNICA)

Russo¹,

Cordier

Catte³

et al. 2018

Prenatal Diagnosis

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Congenital diaphragmatic hernia is a rare disease associated with high mortality and morbidity. Antenatal ultrasound screening identifies more than 70% of cases, providing the opportunity for in utero referral to a tertiary care center for expert assessment and perinatal management. Additional genetic and morphologic assessment may be used to rule out associated anomalies. In isolated cases, the outcome may be predicted prenatally by medical imaging. The combination of lung size and liver herniation is a widely accepted method to stratify fetuses into groups with an increasing degree of pulmonary hypoplasia and corresponding mortality rates. Ultrasound measurement of the observed to expected lung-to-head ratio (o/e LHR) is most widely used. The o/e LHR is an independent predictor of survival and short-term morbidity. Finally, evaluation of stomach position has recently been introduced as an indirect method to estimate severity of the disease in left-sided defects, as it has been shown to correlate with the proportion of intrathoracic liver. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated CDH and individualized prediction of neonatal outcome.

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Section: Additional Testingmentioning

confidence: 99%

Proposal for standardized prenatal ultrasound assessment of the fetus with congenital diaphragmatic hernia by the European reference network on rare inherited and congenital anomalies (ERNICA)

Russo¹,

Cordier

Catte³

et al. 2018

Prenatal Diagnosis

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“…Diaphragmatic eventration, characterised by defective diaphragmatic muscularisation, can be challenging to differentiate from CDH antenatally. The former shows a cephalic displacement of the diaphragm and is often associated with pleural and/or pericardial effusion [22]. Pathologies associated with CDH include cardiac, renal, central nervous system and gastrointestinal anomalies [23].…”

Section: Imaging Modalities For Cdhmentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

140

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Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

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“…The former shows a cephalic displacement of the diaphragm and is often associated with pleural and/or pericardial effusion ( fig. 5 ) [21] . Distinction between these two entities is important, because of the better prognosis and different management of diaphragmatic eventration.…”

Section: Differential Diagnosis and Associated Anomaliesmentioning

confidence: 99%