Huiyong Hu1#, Xiaoping Jing2#,
Xiuhua Duan3, Leiping Zhou4, Yunfeng
Xu1*
1 Department of the Ultrasonography, Shanghai Children’s Hospital,
Shanghai Jiao Tong University, school of medicine, Shanghai 200040,
China;
2 Department of Traditional Chinese
Medicine,
Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of
medicine, Shanghai 200040, China;
3 Department of Radiology, Shanghai Children’s Hospital, Shanghai Jiao
Tong University, school of medicine, Shanghai 200040, China;
4 Department of Radiology, International Peace Maternity & Child Health
Hospital of China welfare institute, Shanghai Jiao Tong University,
school of medicine, Shanghai 200030, China;
# These authors contributed equally to this work.
* Corresponding author: Yunfeng Xu, Department of the Ultrasonography,
Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of
medicine;
Address: 1400 West Beijing Road, Shanghai, China Lane 24 Zip Code
200040;
Phone: 18917128478
E-mail: xuyunfeng65@163. com (F X).
During a prenatal ultrasonography examination late in the second
trimester, a fetus was found to have a right diaphragmatic hernia
(Figure S1). Multidepartment dynamic monitoring was instituted, and the
fetus was later successfully delivered by cesarean section after fetal
distress became evident. After intubation, the infant was stabilized and
transferred to the Department of Neonatology at our hospital.
The enhanced computed tomography of the chest and stomach displayed
multiple air-filled intestinal shadows in the right chest cavity, the
widest being about 20.0 mm. The right lung, mediastinum, and heart were
compressed and displaced, and most of the lung tissue in the right lung
was consolidated. Atelectasis is evident in the irregular enhancement
shadow at the right upper abdomen, about 43.5 × 32.0 mm in size. The
boundary between some sections and the posterior margin of the right
lobe of the liver was unclear, but the blood supply (hepatic artery and
portal vein branches) was visible (Figure). Blood gases, routine
bloodwork, liver and kidney function, and myocardial enzymes were
essentially normal.
At 40 + 4 weeks, with the infant under total anesthesia, hernia repair
was performed. The liver and intestines in the thoracic cavity were
brought back into the abdominal cavity; the tissues around the hernia
ring in the diaphragm were carefully dissociated; and patch repair and
suturing were performed (Figures S2–S4). After the operation, the
infant’s vital signs were stable and their condition remained good
during follow-up.
Congenital diaphragmatic hernia (CDH) is a potentially fatal birth
defect[1-3]. In China today, all pregnant women
undergo ultrasonography to uncover pregnancy- related
conditions[4]. A “green channel” – that is, a
multidepartment collaborative for the emergency treatment of
perioperative pulmonary hypertension, pulmonary dysplasia, and other
complications in newborns with CDH – has been established, helping to
assure the best prognosis for those infants.