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Lung ultrasound findings in congenital diaphragmatic hernia

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Abstract

Congenital diaphragmatic hernia (CDH) occurs in approximately 1 in 2500 to 5000 infants. The use of lung ultrasound (LUS) for its diagnosis has been reported in only two case reports. The aim of this study was to report the LUS pattern of CDH in a case series of infants with respiratory distress. This case series was part of a cohort enrolled in a larger prospective observational study. LUS was performed at the point-of-care during the first 24 h of life of the neonates and its operation time was measured. Seven cases (six left and one right CDH) were diagnosed. We found that the pattern of LUS for CDH diagnosis includes (1) partial absence of the hyperechoic line representing the normal diaphragmatic profile, (2) partial absence of the pleural line in the affected hemithorax, (3) absence of A lines in the affected area, (4) presence of multi-layered area with hyperechoic contents in motion (normal gut), and (5) possible presence of parenchymatous organs inside the thorax (i.e., liver or spleen).

Conclusion: A description of LUS pattern in infants with CDH is provided. LUS at the point-of-care may allow the prompt diagnosis of CDH and this is particularly useful in cases of missed prenatal diagnosis.

What is Known:

• Congenital diaphragmatic hernia occurs in approximately 1 in 2500 to 5000 infants but the use of lung ultrasound for its diagnosis has been reported in only two case reports.

What is New:

• Research provided a description of lung ultrasound pattern in infants with congenital diaphragmatic hernia.

• Lung ultrasound at the point-of-care may allow a prompt diagnosis of congenital diaphragmatic hernia, particularly useful in cases of missed prenatal diagnosis.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

CXR:

Chest X-ray

IQR:

Interquartile range

LUS:

Lung ultrasound

References

  1. Bagłaj M (2004) Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum. Pediatr Surg Int 20:658–669

    Article  PubMed  Google Scholar 

  2. Bagłaj M, Dorobisz U (2005) Late-presenting congenital diaphragmatic hernia in children: a literature review. Pediatr Radiol 35:478–488

    Article  PubMed  Google Scholar 

  3. Clifton MS, Wulkan ML (2017) Congenital diaphragmatic hernia and diaphragmatic eventration. Clin Perinatol 44:773–779

    Article  PubMed  Google Scholar 

  4. Corsini I, Parri N, Gozzini E, Coviello C, Leonardi V, Poggi C, Giacalone M, Bianconi T, Tofani L, Raimondi F, Dani C (2019) Lung ultrasonography for the differential diagnosis of respiratory distress in neonates. Neonatology 115:77–84. https://doi.org/10.1159/000493001

    Article  PubMed  Google Scholar 

  5. Desjardins MP, Weerdenburg KD, Fischer JW (2016) Emergency point-of-care ultrasound diagnosis of diaphragmatic hernia in the pediatric emergency department. Pediatr Emerg Care 32(10):685–687

    Article  PubMed  Google Scholar 

  6. Gallot D, Coste K, Francannet C, Laurichesse H, Boda C, Ughetto S, Vanlieferinghen P, Scheye T, Vendittelli F, Labbe A, Dechelotte PJ, Sapin V, Lemery D (2006) Antenatal detection and impact on outcome of congenital diaphragmatic hernia: a 12-year experience in Auvergne (France). Eur J Obstet Gynecol Reprod Biol 125:202–205

    Article  PubMed  Google Scholar 

  7. Garne E, Haeusler M, Barisic I, Gjergja R, Stoll C, Clementi M (2002) Congenital diaphragmatic hernia: evaluation of prenatal diagnosis in 20 European regions. Ultrasound Obstet Gynecol 19:329–333. https://doi.org/10.1046/j.1469-0705.2002.00635.x

    Article  PubMed  CAS  Google Scholar 

  8. Oluyomi-Obi T, Van Mieghem T, Ryan G (2017) Fetal imaging and therapy for CDH-current status. Semin Pediatr Surg 26:140–146

    Article  PubMed  Google Scholar 

  9. Raimondi F, Yousef N, Migliaro F, Capasso L, De Luca D (2018) Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res. https://doi.org/10.1038/s41390-018-0114-9.

  10. Rankin JH, Elkhunovich M, Seif D, Chilstrom M (2016) Point-of-care ultrasound diagnosis of diaphragmatic hernia in an infant with respiratory distress. Pediatr Emerg Care 32:731–733

    Article  PubMed  Google Scholar 

  11. Yousef N, Mokhtari M, Durand P, Raimondi F, Migliaro F, Letourneau A, Tissières P, de Luca D (2018 Oct) Lung ultrasound findings in congenital pulmonary airway malformation. Am J Perinatol 35(12):1222–1227. https://doi.org/10.1055/s-0038-1645861

    Article  PubMed  Google Scholar 

  12. Zalla JM, Stoddard GJ, Yoder B (2015) Improved mortality rate for congenital diaphragmatic hernia in the modern era of management: 15 year experience in a single institution. J Pediatr Surg 50:524–527. https://doi.org/10.1016/j.jpedsurg.2014.11.002

    Article  PubMed  Google Scholar 

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Author notes

  1. Iuri Corsini and Niccolò Parri contributed equally to this work.

Authors and Affiliations

  1. Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla, 3, 50134, Florence, Italy

    Iuri Corsini, Caterina Coviello, Valentina Leonardi & Carlo Dani

  2. Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children’s Hospital, Florence, Italy

    Niccolò Parri

  3. Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy

    Carlo Dani

Authors
  1. Iuri Corsini
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  2. Niccolò Parri
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  3. Caterina Coviello
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  4. Valentina Leonardi
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  5. Carlo Dani
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Contributions

Dr. Iuri Corsini and Dr. Niccolò Parri has equally contributed to the paper, serve as guarantors of the paper, and were responsible for study conception, design, execution, data analysis, and writing the manuscript.

Dr. Caterina Coviello and Dr. Valentina Leonardi enrolled patients, designed the data collection instruments, collected data reviewed, and revised the manuscript.

Prof. Carlo Dani supervised the project, provided oversight of the study, refined the study design and the design of the study protocol and data form, and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Iuri Corsini.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local Ethical Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Communicated by Patrick Van Reempts

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Electronic supplementary material

Supplemental video 1

Transverse subcostal view of the abdomen. Note the absence of the hyperechoic line representing the diaphragm in a neonate with left CDH. (MOV 418 kb)

Ultrasonographic findings of CDH. Note the absence of the hyperechoic line that represents the pleura and the absence of the normal A lines. The presence of a multi-layered area with hyperechoic contents typical of the normal intestine instead of the normal pulmonary parenchyma can be seen. (MOV 13597 kb)

Supplemental video 3

Ultrasonographic findings of CDH. Note the absence of the hyperechoic line that represents the pleura and the absence of the normal A lines. It is possible to see the parenchymatous organ (liver) instead of the normal pulmonary parenchyma. (MOV 19280 kb)

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Corsini, I., Parri, N., Coviello, C. et al. Lung ultrasound findings in congenital diaphragmatic hernia. Eur J Pediatr 178, 491–495 (2019). https://doi.org/10.1007/s00431-019-03321-y

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  • DOI: https://doi.org/10.1007/s00431-019-03321-y

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