Fig. 3

Anatomical and radiological features of CDH – A defect in the diaphragm causes the abdominal viscera to herniate into the thoracic cavity. Left sided hernias are common (85%) which results in herniation of both small and large intestines along with solid intra-abdominal organs. Herniation of viscera into the thoracic cavity results in abnormal lung development on the ipsilateral side with variable effect on the contralateral side. The effect of abnormal lung development on the contralateral side depends on the extent of herniation and the effect on mediastinal shift. Pulmonary hypoplasia results in abnormal pulmonary vasculature resulting in persistent pulmonary hypertension leading to right ventricular dysfunction. This is more pronounced after transitioning from fetal circulation. Left ventricular dysfunction can be secondary to direct compression in left sided hernia and secondary to low ventricular volumes in right sided hernias. Pre-operative chest and abdomen x-ray shows the air and fluid filled loops of bowels on the left side of the thorax with the endotracheal tube above the thoracic vertebra level 4 pushed towards the right side signifying mediastinal shift. (Copyright Satyan Lakshminrusimha)