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Case For The Month
 

Case of Diaphragmatic Hernia  


Case Summary: -

G3 P2 with previous normal children, was scanned at 19-20 weeks as a part of 20 weeks scan. Scan revealed all Biometric Measurements within normal range. There was no evidence of hydramnios.

Abdominal Circumference plane showed AC of 147 mm2.


Thoracic Circumference plane showed Thx Circumference of 209 mm2.

Since thoracic circumference was significantly larger than the abdominal circumference, more detailed and careful scanning was done.

Transverse image at the level of 4 chamber showed- Heart on the right side, Stomach on the left side and both seen at the same transverse plane.

     

This gave suspicion of Diaphragmatic Hernia.

3D scanning was done

This showed a defect in the posterolateral aspect of the diaphragm with stomach herniating and heart shifted to the right side.

     

 

Generating the saggital plane using 3D technology showed the herniation of the stomach posteriorly.

 
 
This case study reveals the importance of simple steps in 20 weeks scan.

These steps are:-
  • Careful comparison of AC and Thx circumference.
  • Localisation of the stomach bubble.
  • Asessing Cardiac situs.
  • Asessing Visceral situs
This can help one in diagnosis of major malformations in the absence of "tell-tale" signs like hydramnios.

 

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