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Paradoxical Movement of Abdominal Contents

A Real-time Sonographic Finding Indicating a Congenital Diaphragmatic Hernia

Department of Radiology, University of California, San Francisco, California USA.

Address correspondence to Roy A. Filly, MD, Department of Radiology, University of California, 505 Parnassus Ave, L374, San Francisco, CA 94143-0628 USA. E-mail: roy.filly{at}radiology.ucsf.edu

Objective. A congenital diaphragmatic hernia (CDH) is the most common intrathoracic extracardiac congenital anomaly, and it is associated with high mortality and other fetal abnormalities. Early diagnosis is essential for delivery planning and possible intervention. However, the in utero diagnosis of CDHs by sonography can be challenging. We report the utility of paradoxical movement of the intra-abdominal contents in identifying CDHs. Methods. Two fetal cases were identified: 1 referred with a suspected CDH and the other with a mediastinal shift and a suspected congenital cystic adenomatoid malformation (CCAM). Real-time sonography was performed in both fetuses with attention on movement of the intra-abdominal contents during fetal breathing, particularly during inspiration. Results. Real-time sonography in both fetuses showed paradoxical movement of the abdominal contents during fetal inspiration. In the case with the presumptive diagnosis of a CCAM, the paradoxical motion was essential in changing the diagnosis from a CCAM to a CDH. Conclusions. Paradoxical movement of the abdominal contents can be used in addition to the traditional sonographic signs in diagnosing CDHs.

Key Words: congenital diaphragmatic hernia • fetal sonography • paradoxical motion • real-time sonography

Abbreviations: CDH, congenital diaphragmatic hernia

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