Congenital diaphragmatic hernia--a review of pre- and postoperative chest radiology.

The clinical and pre- and postoperative radiographic features of 63 babies who presented with congenital (Bochdalek) diaphragmatic hernias were reviewed. Fifty-five babies presented in the neonatal period and eight in later childhood. For neonatal presenters, the preoperative radiographic features were typical in all cases but one (presented with persistent right pleural effusion). Features associated with a poorer prognosis included the presence of a contralateral pneumothorax, absence of contralateral aerated lung and an intrathoracic site for the stomach. Identification of ipsilateral aerated lung was associated with survival in all cases. Typical postoperative features included an ipsilateral pneumothorax, gradual expansion of the lung, gradual elevation of the hemidiaphragm and pleural effusion. Follow-up films demonstrated reduced vascularity in the ipsilateral lung which was commonly smaller than the contralateral lung. The postoperative radiographic features for delayed presenters differed in that lung expansion was usually complete on the first postoperative radiograph and there was no radiographic evidence of pulmonary vascular hypoplasia.