Congenital diaphragmatic hernia (CDH) is a life-threatening fetal anomaly characterized by herniation of abdominal contents into the thoracic cavity due to a defect in the diaphragm, most commonly left-sided. Accurate prenatal diagnosis and risk stratification are essential for guiding perinatal management, parental counseling, and prognostication. While ultrasound remains the first-line modality for initial detection, fetal MRI provides superior soft tissue contrast and volumetric assessment, offering critical additional information, particularly in complex or equivocal cases. This educational exhibit serves as a practical guide for radiologists interpreting fetal MRI for CDH. We review the typical imaging features of CDH on MRI, including identification of herniated organs, mediastinal shift, and assessment of the ipsilateral and contralateral lungs. Emphasis is placed on the standardized approach to measuring total and observed-to-expected lung volumes (o/e TLV), as well as lung area to head cicumference ratio (LHR), which serve as key prognostic markers. The exhibit also addresses the significance of liver position, stomach location, and diaphragmatic defect size, all of which correlate with postnatal outcomes and surgical complexity. We illustrate how MRI findings influence the clinical decision-making process, including eligibility for fetal intervention such as fetoscopic endoluminal tracheal occlusion (FETO). Radiologists play a vital role in the multidisciplinary care of these patients by providing accurate and reproducible measurements that impact prognosis and management. This exhibit aims to equip radiologists with the essential tools and knowledge required to confidently evaluate CDH on fetal MRI and contribute meaningfully to perinatal planning. Read More

Meeting name: IPR 2026 Congress , 2026

Authors: Mousa Abeer, Perez Rachel, Goncalves Luis

Keywords: Fetal, Congenital Diaphragmatic Hernia, Lung

Congenital high airway obstruction syndrome (CHAOS) is a rare but life-threatening fetal condition resulting from obstruction of the fetal upper airway, most commonly due to laryngeal or tracheal atresia. Accurate prenatal diagnosis is critical for perinatal management and potential surgical planning, including consideration of an ex utero intrapartum treatment (EXIT) procedure. While ultrasound is typically the initial modality for detection, fetal MRI provides superior anatomic detail and plays an increasingly important role in confirming the diagnosis, assessing the level and extent of obstruction, and evaluating associated anomalies. In this case series, we present fetal MRI findings from four cases of CHAOS, each diagnosed in the second trimester. MRI demonstrated hallmark features including bilaterally enlarged, hyperintense lungs on T2-weighted images, flattened or inverted diaphragms, central compression of the heart, and dilated airways distal to the point of obstruction. Associated anomalies, including ascites and hydrops fetalis, were variably present. In all cases, MRI provided critical information for determining the severity and level of obstruction, distinguishing CHAOS from other causes of airway obstruction or other thoracic masses such as congenital pulmonary airway malformation (CPAM), and aiding multidisciplinary decision-making regarding delivery planning and neonatal resuscitation. This case series underscores the diagnostic value of fetal MRI in the evaluation of CHAOS and highlights key imaging features that can facilitate accurate prenatal diagnosis. Early and precise recognition of this rare condition allows for appropriate counseling of expectant parents and coordination of specialized perinatal interventions that may improve neonatal outcomes. Read More

Meeting name: IPR 2026 Congress , 2026

Authors: Mousa Abeer, Perez Rachel, Goncalves Luis

Keywords: Fetal, Airway, Atresia