Can ultrasound differentiate between right diaphragmatic hernia and eventration?
Purpose or Case Report: Radiographic findings of right diaphragmatic eventration may overlap with true hernia if only liver herniates without bowel. We thus wanted to know the accuracy of ultrasonography (US) in the diagnosis of right diaphragmatic hernia.
Methods & Materials:
We identified all patients (2007-2016) who had US of the right diaphragm, and surgery for eventration or hernia. The medical record was reviewed for clinical presentation and surgical or pathologic diagnosis. US studies were reviewed for any diaphragm abnormalities. Surgical or pathology diagnosis was considered the gold standard.
16 children (8 females, age range birth-16 months, mean 5.2 months) had US as well as surgery for eventration (n=7) or hernia (n=9; 6 Bochdalek and 3 Morgagni). The most common presentation was respiratory distress (12/16, 75%).
US correctly diagnosed all 9 patients with hernia and misdiagnosed 3 patients with eventration, yielding 100% sensitivity for hernia, 57% specificity, and 81% accuracy.
Presence of at least one of the following US findings increased the specificity to 86% with 100% sensitivity, and 94% accuracy: folding of the free diaphragmatic edge (n=8) or liver seen cranial to the diaphragm muscle (n=7).
Conclusions: US imaging can be useful in the diagnosis of diaphragmatic hernia, although it is important to recognize presence of folding of free diaphragmatic edge and liver above the diaphragm muscle to improve specificity and overall accuracy.