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Case of the Week # 203

Fabrice Cuillier, MD; J. Narboni, MD; J. L. Alessandri, MD; L. Vinatier, MD; S. Napoli, MD

October 4 - October 18, 2007

Fabrice Cuillier, MD*; J. Narboni, MD**; J. L. Alessandri, MD***; L. Vinatier, MD****; S. Napoli, MD*****.

*      Department of Gynecology, Félix Guyon'Hospital, 97400 Saint-Denis, Ile de la Réunion, France;
**     Radiologist, Hospital, 97400 Saint-Denis, Ile de la Réunion, France;
***    Department of Neonatology, Félix Guyon'Hospital, 97400 Saint-Denis, Ile de la Réunion
****   Assistante, CHD Felix Guyon, Reunion Island, France;
*****  Pediatric surgeon, CHD Felix Guyon, Reunion Island, France.

Case report

This is a 24-year-old G1P0, with unremarkable family history, referred to our antenatal unit at 33 weeks of gestation. The amount of amniotic fluid was normal and the growth of the baby was concordant with the gestational age. Her first trimester sonography and triple test were normal, so was the second trimester ultrasound performed at 24th week. An amniocentesis was done with normal karyotype (46, XX).

Image 1 and 2.

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Image 3 and 4. 

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Image 5 and 6.

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Video 1. 

 

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Answer

Case report

This is a 24-year-old G1P0, with unremarkable family history, referred to our antenatal unit at 33 weeks of gestation because of fetal left diaphragmatic hernia. The amount of amniotic fluid was normal and the growth of the baby was concordant with the gestational age. Her first trimester sonography and triple test were normal, so was the second trimester ultrasound performed at 24th week.

During our ultrasound investigation at 33 weeks we could see:

  • Left diaphragmatic hernia, with left intrathoracic position of the stomach, colon and spleen;
  • Dextroposition of the heart;
  • The rest of the fetus was normal.

An amniocentesis was done with normal karyotype (46, XX). The patient delivered vaginally at 37th week. The baby weight 3000 g and underwent X-ray examination. A diagnosis of diaphragmatic eventration was suspected and was confirmed during the surgical operation. Postoperative course was without complications.

Conclusion

Later onset of fetal "diaphragmatic hernia" during pregnancy should lead our differential diagnosis contemplation to the diagnosis of diaphragmatic eventration.

Image 1 and 2. Transverse gray scale and color Doppler images through the fetal thorax showing dextroposition of the heart with protruding stomach and bowels to the thoracic cavity.

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1B

Image 3 and 4. Transverse gray scale and color Doppler images through the fetal thorax showing dextroposition of the heart with protruding stomach, spleen, and bowels to the thoracic cavity.

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Image 4

Image 5 and 6. Sagittal gray scale images showing the stomach behind the heart in the thoracic cavity.

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Image 7 and 8. Transverse gray scale images through the fetal thorax showing dextroposition of the heart with protruding stomach, spleen, and bowels to the thoracic cavity.

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Video 1. Color Doppler ultrasound showing dextroposition of the heart with protruding stomach, and bowels to the thoracic cavity.

Image 9 and 10. X-ray images of the baby after delivery (image 9) and post operation (image 10).

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