Link: https://www.ncbi.nlm.nih.gov/pubmed/30635693

Pediatr Radiol. 2019 Jan 11. doi: 10.1007/s00247-018-04334-9. [Epub ahead of print]
Congenital diaphragmatic hernia sacs: prenatal imaging and associated postnatal outcomes.
Oliver ER1,2,3, DeBari SE4,5, Adams SE4,6, Didier RA7,4,5, Horii SC7,4,8, Victoria T7,4,5, Hedrick HL7,4,6, Adzick NS7,4,6, Howell LJ4,6, Moldenhauer JS7,4,6, Coleman BG7,4,5.
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Abstract
BACKGROUND:
The presence of a hernia sac in congenital diaphragmatic hernia (CDH) has been reported to be associated with higher lung volumes and better postnatal outcomes.

OBJECTIVE:
To compare prenatal imaging (ultrasound and MRI) prognostic measurements and postnatal outcomes of CDH with and without hernia sac.

MATERIALS AND METHODS:
We performed database searches from January 2008 to March 2017 for surgically proven cases of CDH with and without hernia sac. All children had a detailed ultrasound (US) examination and most had an MRI examination. We reviewed the medical records of children enrolled in our Pulmonary Hypoplasia Program.

RESULTS:
Of 200 cases of unilateral CDH, 46 (23%) had hernia sacs. Cases of CDH with hernia sac had a higher mean lung-to-head ratio (LHR; 1.61 vs. 1.17; P<0.01), a higher mean observed/expected LHR (0.49 vs. 0.37; P<0.01), and on MRI a higher mean observed/expected total lung volume (0.53 vs. 0.41; P<0.01). Based on a smooth interface between lung and herniated contents, hernia sac or eventration was prospectively questioned by US and MRI in 45.7% and 38.6% of cases, respectively. Postnatally, hernia sac is associated with shorter median periods of admission to the neonatal intensive care unit (45.0 days vs. 61.5 days, P=0.03); mechanical ventilation (15.5 days vs. 23.5 days, P=0.04); extracorporeal membrane oxygenation (251 h vs. 434 h, P=0.04); decreased rates of patch repair (39.0% vs. 69.2%, P<0.01); and pulmonary hypertension (56.1% vs. 75.4%, P=0.03).

CONCLUSION:
Hernia sac is associated with statistically higher prenatal prognostic measurements and improved postnatal outcomes. Recognition of a sharp interface between lung and herniated contents may allow for improved prenatal diagnosis; however, delivery and management should still occur at experienced quaternary neonatal centers.

KEYWORDS:
Congenital diaphragmatic hernia; Hernia sac; Lung-to-head ratio; Magnetic resonance imaging; Neonates; Prenatal ultrasound; Total lung volume

PMID: 30635693 DOI: 10.1007/s00247-018-04334-9