Radiographic changes in the diaphragm after repair of congenital diaphragmatic hernia.
OBJECTIVE
The growth and function of the repaired diaphragm have not been well elucidated, which may contribute to pulmonary function and chest wall deformity. We measured the lower lung diameter at the top of the diaphragm (LLD), diaphragmatic diameter (DD), and diaphragmatic height (DH) on the posteroanterior plain chest radiograph using a picture archive and communication system.


METHODS
Thirty-six children aged 10.4 +/- 4.8 years with congenital diaphragmatic hernia underwent clinical evaluation, including plain chest radiograph and a lung ventilation/perfusion scan. As a control, chest radiographs of 89 children aged 9.0 +/- 5.5 years with minor surgery were analyzed.


RESULTS
The LLD, DD, and DH in controls were significantly correlated with age; each value was then expressed as a percentage of age-based estimated values. Ipsilateral LLD and DD were significantly decreased. The perfusion of the ipsilateral lung was best correlated with ipsilateral DD. Five patients had chest wall deformity, and 7 had scoliosis (Cobb angle >10 degrees ). Patients with scoliosis had decreased ipsilateral LLD, DD, and DH. The Cobb angle was correlated with LLD and DD.


CONCLUSIONS
The growth of the repaired diaphragm may be impaired, which contributes to decreased perfusion of the ipsilateral lung and scoliosis. The LLD and DD are simple but useful parameters in the follow-up of patients with CDH.
Kamata
Shinkichi
S
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. kamata@pedsurg.med.osaka-u.ac.jp
Usui
Noriaki
N
Sawai
Toshio
T
Nose
Keisuke
K
Kamiyama
Masafumi
M
Fukuzawa
Masahiro
M
D000293:Adolescent; D001827:Body Height; D001835:Body Weight; D002648:Child; D003964:Diaphragm / Q000000981:diagnostic imaging* / Q000254:growth & development / Q000473:pathology; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D011877:Radionuclide Imaging; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology; D014692:Ventilation-Perfusion Ratio