Diaphragm ultrasound examination for congenital diaphragmatic eventration in two premature neonates

Abstract

Congenital diaphragmatic eventration (CDE) is always diagnosed by fluoroscopic examination. However, this technique is inappropriate for premature neonates because of risks of transport, hypothermia and ionising radiation. Herein, we describe two cases of premature neonates suspected to have CDE on radiography. We could not perform fluoroscopic examination due to their prematurity status. Therefore, we performed ultrasound examination and succeeded in diagnosing CDE without any risks. Using ultrasound examination, we could evaluate movement and thickness of the diaphragm. We consider this additional information useful for CDE diagnosis. This is the first report on CDE diagnosis using ultrasound examination.

Keywords: neonatal intensive care; ultrasonography.

Figure 1

(A) During inspiration, the left diaphragm moved towards the transducer, but lack of movement of the right diaphragm was noticed (arrow). (B) The diaphragm was visualised as a hypoechoic structure between two hyperechoic lines in the zone of apposition (arrows). From the end of expiration to inspiration, the right diaphragm could not be measured because it was too thin, and the thickness of the left diaphragm changed from 0.92 to 1.54 mm. (C) The left diaphragm showed an average excursion of 5.2 mm. The right diaphragm showed an average excursion of 1.8 mm.

Figure 2

(A) During inspiration, the right diaphragm moved towards the transducer, but lack of movement of the left diaphragm was noticed (arrow). (B) The diaphragm was visualised as a hypoechoic structure between two hyperechoic lines in the zone of apposition (arrows). From the end of expiration to inspiration, the thickness of the right diaphragm changed from 1.62 to 2.32 mm, and the thickness of the left diaphragm changed from 0.42 to 0.6 mm. (C) The right diaphragm showed an average excursion of 5.0 mm. The left diaphragm showed an average excursion of 2.1 mm.