Purpose or Case Report: Late-presenting or recurrent diaphragmatic defects can pose a diagnostic challenge due to varying clinical presentations. Current diagnostic approaches include plain film radiograph for initial assessment, with other imaging modalities such as fluoroscopy, ultrasound, CT and MRI mainly employed for troubleshooting. As a radiation-free modality, MRI can provide a more definitive diagnosis in particular cases due to its ability to visualize discontinuity of the diaphragm (distinguishing it from eventration), hernia contents, defect location and size.

In this exhibit, we will:
1. Review the normal appearance of the diaphragm.
2. Share our institutional MRI protocol for optimal evaluation of the diaphragm, including use of CINE steady state free precession sequences and use of negative slice spacing in T2 weighted images.
3. Discuss important postnatal MR imaging findings of late presenting and recurrent diaphragmatic hernias in children.
4. Describe potential diagnostic pitfalls in the imaging of the diaphragm.
Methods & Materials: We present MRI cases performed for suspicion of late presenting and recurrent diaphragmatic hernias at two academic pediatric hospitals. Representative cases were selected to demonstrate a variety of hernia types and contents, which were correlated with other available imaging modalities, clinical course and intraoperative findings.
Results: Select MRI cases of different hernia types including late presenting Bochdalek and Morgagni hernias, acquired hiatal hernias, and recurrent congenital diaphragmatic hernias are reviewed with relevant discussion of the imaging findings and correlation with intraoperative findings.
Conclusions: MRI can be a useful diagnostic tool in the assessment of late presenting or recurrent diaphragmatic hernias.