Diaphragm

Abstract

General considerations

■ Postero-lateral diaphragmatic defect (usually on the left side) (Fig. 17.1, Table 17.1) with communicating thoracic and abdominal spaces

■ Generally accompanied by lung hypoplasia, which may be secondary to compression by the herniated viscera or a primary pulmonary defect. Both lungs are affected, particularly the one ipsilateral to the lung defect

■ In left-sided hernias the stomach, the small bowel, and part of the colon are usually located in the thorax. The left lobe of the liver and the spleen may also be involved. In cases of dorsal aplasia of the diaphragm, the adrenal gland and even the kidney may be displaced into the thorax

■ In right-sided hernias the liver and the small and large bowel may be located in the thorax

■ Many associated malformations may be present in addition to lung hypoplasia: malrotation, cardiovascular defects, lung sequestration, and others