Presentation
Unremarkable history. Incidental findings on routine pregnancy US screening.
Patient Data
Thoracic and abdominal situs concords, with both heart and stomach on the left side.
MR allows better visualization of lung and liver: lung's signal is hyper T2W while liver's signal is hypo T2W.
Case Discussion
Most diaphragmatic hernias (90%) are left-sided, thus right-sided account for only 10% of the cases. Diagnosis of left-sided is usually easier thanks to the stomach acting as an acoustic window. US contrast resolution often results in difficulties in distinguishing lung from liver in standard screening, hence small right-sided diaphragmatic hernias may be missed.
MR imaging depicts a clearer image of the anatomy, thanks to its multiplanar analysis and improved contrast. In fetal US the lung to head ratio is employed, whilst with MR provides additional prognostic factors with estimated fetal lung volume assessment, which is compared to normal fetal lung volume expected for gestational age.
Right-sided hernia may be part of a wider pathology, e.g. Fryns syndrome, which includes additional facial and limb anomalies; this is not the case here.
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