Postnatally diagnosed coexisting congenital diaphragmatic hernia with pulmonary sequestration: a report of two cases

Abstract

While the associations between pulmonary sequestration (PS) and congenital diaphragmatic hernia (CDH) are known, CDH may be obscured by PS and thus, overlooked on prenatal ultrasonography when coexisting with PS. We present 2 cases of postnatally diagnosed CDH combined with PS. In both cases, PS was prenatally diagnosed as an isolated lung mass, while CDH was confirmed only after birth. Both newborns were sufficiently stable that management was not required immediately after birth. PS may function as an "anatomical barrier" to prevent herniation of the abdominal contents into the chest, thus acting as a "protector" providing normal lung maturation throughout pregnancy. If PS is suspected prenatally, coexisting CDH may be obscured; thus, close prenatal care and counseling of the parents regarding the possibility of CDH are essential. These infants should be delivered at a tertiary center, and imaging should be performed to exclude coexisting CDH.

Keywords: Congenital diaphragmatic hernias; Prenatal ultrasonography; Pulmonary sequestration.

Fig. 1.

Prenatal and postnatal findings in Case 1. Prenatal ultrasonographic image showing (A) a hyperechoic mass (asterisk) on the posterior right lower lung on the transverse view and (B) elevated right kidney (arrowheads) beneath the lung mass on the coronal view. (C) Postnatal computed tomography image showing the liver, right kidney, and some bowel loops in the right lung field as well as right lung hypoplasia. (D) Postoperative histopathological findings of the extralobar lung sequestration showing immature pulmonary parenchyma with bronchiole-like structures with pseudocystic dilatation.

Fig. 2.

Prenatal and postnatal findings in Case 2. Prenatal ultrasonographic image showing (A) a hyperechoic mass (asterisk) in the left upper abdominal cavity in the sagittal view and (B) posterior to the stomach in the transverse view. (C) Color Doppler ultrasonographic image showing that the lung mass received blood supply from the descending aorta. (D) Computed tomography image after birth showing the stomach fundus and presumed extralobar lung sequestration positioned below the diaphragm herniated into the left thorax.