Purpose or Case Report: Congenital diaphragmatic hernia (CDH) is the result of incomplete closure of the normal pleuroperitoneal canal. CDH is usually detected prenatally or present in the newborn period with severe respiratory distress. In contrast, delayed presentation of CDH (D-CDH), defined as CDH diagnosed at later than 30 days of age, is known as rare subset of CDH. The outcome of patients with D-CDH is generally favorable, but misdiagnosis can result in morbidity and mortality. This educational exhibit will demonstrate clinico-radiological characteristics of D-CDH.
Methods & Materials: Materials include 8 patients with surgery proven D-CDH. Age at the time of diagnosis ranged from 2-month-old to 6-year and 6-month-old. There were each of 4 girls and boys. Affected side was left in all 8. We retrospectively reviewed as follows; 1. Chief clinical symptom, 2. Type of diagnostic imaging studies performed prior to surgery, 3. Tentative diagnosis based on symptoms at presentation, 4. Number of patient diagnosed as D-CDH prior to surgery, 5. Time required for final diagnosis since onset of symptom, 6. Type of herniated organ, and 7. Pre- and post-operative clinical course.
Results: 1. Chief clinical symptom was varied including respiratory symptom in 3, gastrointestinal symptom in 3, respiratory and gastrointestinal symptoms in 1, and failure to thrive in 1. 2. Preoperative diagnostic imaging studies were conventional chest and abdominal radiograph in all 8, unenhanced chest and abdominal CT in 1, enhanced chest and abdominal CT in 6, upper gastrointestinal series in 2, lower gastrointestinal series in 1, and abdominal ultrasound in 1. Seven patients underwent at least 2 diagnostic imaging studies. 3. Tentative diagnoses based on symptoms at presentation were varied but none of them was D-CDH. 4. All of 8 patients reached final diagnosis of D-CDH prior to surgery. 5. Time required for final diagnosis since onset of symptom varied from 3 hours to 7 months, 6. There were a variety of herniated organs including stomach in 2, small intestine in 7, colon in 6, spleen in 4. One patient was diagnosed having gastric volvulus. 7. Pre-operative clinical course was favorable except for 2 patients with respiratory distress. Post-operative clinical course was uneventful in all 8 patients.
Conclusions: D-CDH can present with a variety of symptoms usually that of acute symptom. Proper use of diagnostic imaging study is vital for correct preoperative diagnosis.