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Lung ultrasound findings in congenital diaphragmatic hernia

  • Iuri CorsiniEmail author
  • Niccolò Parri
  • Caterina Coviello
  • Valentina Leonardi
  • Carlo Dani
Original Article

Abstract

Congenital diaphragmatic hernia (CDH) occurs in approximately 1 in 2500 to 5000 infants. The use of lung ultrasound (LUS) for its diagnosis has been reported in only two case reports. The aim of this study was to report the LUS pattern of CDH in a case series of infants with respiratory distress. This case series was part of a cohort enrolled in a larger prospective observational study. LUS was performed at the point-of-care during the first 24 h of life of the neonates and its operation time was measured. Seven cases (six left and one right CDH) were diagnosed. We found that the pattern of LUS for CDH diagnosis includes (1) partial absence of the hyperechoic line representing the normal diaphragmatic profile, (2) partial absence of the pleural line in the affected hemithorax, (3) absence of A lines in the affected area, (4) presence of multi-layered area with hyperechoic contents in motion (normal gut), and (5) possible presence of parenchymatous organs inside the thorax (i.e., liver or spleen).

Conclusion: A description of LUS pattern in infants with CDH is provided. LUS at the point-of-care may allow the prompt diagnosis of CDH and this is particularly useful in cases of missed prenatal diagnosis.

What is Known:

Congenital diaphragmatic hernia occurs in approximately 1 in 2500 to 5000 infants but the use of lung ultrasound for its diagnosis has been reported in only two case reports.

What is New:

Research provided a description of lung ultrasound pattern in infants with congenital diaphragmatic hernia.

Lung ultrasound at the point-of-care may allow a prompt diagnosis of congenital diaphragmatic hernia, particularly useful in cases of missed prenatal diagnosis.

Keywords

Congenital diaphragmatic hernia Lung ultrasound Neonate Intensive care 

Abbreviation

CDH

Congenital diaphragmatic hernia

CXR

Chest X-ray

IQR

Interquartile range

LUS

Lung ultrasound

Notes

Authors’ contributions

Dr. Iuri Corsini and Dr. Niccolò Parri has equally contributed to the paper, serve as guarantors of the paper, and were responsible for study conception, design, execution, data analysis, and writing the manuscript.

Dr. Caterina Coviello and Dr. Valentina Leonardi enrolled patients, designed the data collection instruments, collected data reviewed, and revised the manuscript.

Prof. Carlo Dani supervised the project, provided oversight of the study, refined the study design and the design of the study protocol and data form, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local Ethical Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

431_2019_3321_MOESM1_ESM.mov (419 kb)
Supplemental video 1 Transverse subcostal view of the abdomen. Note the absence of the hyperechoic line representing the diaphragm in a neonate with left CDH. (MOV 418 kb)
Supplemental video 2

Ultrasonographic findings of CDH. Note the absence of the hyperechoic line that represents the pleura and the absence of the normal A lines. The presence of a multi-layered area with hyperechoic contents typical of the normal intestine instead of the normal pulmonary parenchyma can be seen. (MOV 13597 kb)

431_2019_3321_MOESM3_ESM.mov (18.8 mb)
Supplemental video 3 Ultrasonographic findings of CDH. Note the absence of the hyperechoic line that represents the pleura and the absence of the normal A lines. It is possible to see the parenchymatous organ (liver) instead of the normal pulmonary parenchyma. (MOV 19280 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of NeonatologyCareggi University Hospital of FlorenceFlorenceItaly
  2. 2.Department of Pediatric Emergency Medicine and Trauma CenterMeyer University Children’s HospitalFlorenceItaly
  3. 3.Department of Neurosciences, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly

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