Journal of Ultrasound in Medicine, Vol 14, Issue 7 515-520, Copyright © 1995 by American Institute of Ultrasound in Medicine
Prenatal sonographic predictors of liver herniation in congenital diaphragmatic hernia
B. S. Bootstaylor, R. A. Filly, M. R. Harrison and N. S. Adzick
Department of Radiology, University of California, San Francisco 94143, USA.
We conducted a retrospective review of prenatal sonograms of all fetuses (n
= 25) with left sided congenital diaphragmatic hernia undergoing in utero
surgical repair of the defect at the University of California, San
Francisco, Fetal Treatment Center. Sixteen candidates were selected for
analysis to determine reliable predictors of liver herniation. Bowing of
the umbilical segment of the portal vein (portal sinus) to the left of
midline and coursing of portal branches to the lateral segment of the left
hepatic lobe toward or above the diaphragmatic ridge were the best
predictors for liver herniation into the fetal thorax (positive predictive
values of 85% and 100%, respectively). The stomach position was a good
predictor if observed in a posterior or midthoracic location (positive
predictive value = 100%). However, this occurred in only 7 of 16 (44%)
cases. Visibility of the right lung was less informative (positive
predictive value = 63%). We do not recommend in utero primary closure of
congenital diaphragmatic hernia when there is sonographic evidence of liver
herniation into the fetal thorax.
