Embrolygically when is the diapragm formed?
The diaphragm is formed between the 5th and 7th weeks of gestation through the progressive fusion of the septum transversum, pleuroperitoneal folds and via lateral muscular ingrowth.
What are the two types of diagpramatic hernias?
- Bochdalek hernia
What is a Morgagni hernia?
- Anteriorly located
- Minimal compromise on lung development
- Minimal signs on antenatal ultrasound
- Usually present later
- Usually good prognosis
What is aBochdalek hernia?
- Posteriorly located
- Larger defect
- Often diagnosed antenatally
- Associated with pulmonary hypoplasia
- Poor prognosis
What are the most common type of hernia?
- The posterior hernias of Bochdalek are the most common type and if not diagnosed antenatally will typically present soon after birth with respiratory distress.
- The classical finding is that of a scaphoid abdomen on clinical examination because of herniation of the abdominal contents into the chest.
What are the chromosomal abnormalities associated with Bochdalek hernias?
- Trisomy 21 and 18.
- Infants have considerable respiratory distress due to hypoplasia of the developing lung.
- Historically this was considered to be due to direct compression of the lung by herniated viscera.
- This view over simplifies the situation and the pulmonary hypoplasia occurs concomitantly with the hernial development, rather than as a direct result of it.
- The pulmonary hypoplasia is associated with pulmonary hypertension and abnormalities of pulmonary vasculature.
- The pulmonary hypertension renders infants at risk of right to left shunting (resulting in progressive and worsening hypoxia).
Diagnostic work up?