P05.08: Isolated Right Diaphragmatic Hernia Mimicking Congenital Heart Disease in Utero

Prenatal diagnosis of right sided CDH is difficult and the clinical and radiological presentations, which are well documented in left-sided diaphragmatic hernia, are variable in right-sided diaphragmatic hernia. It is often suggested by indirect signs, such as intrathoracic stomach. Prenatal diagnosis of right sided CDH is difficult and is suggested by indirect signs, such as intrathoracic liver (helped by color Doppler evaluation of hepatic veins as liver and lung are iso-echoic prenatally), intrathoracic gall bladder and mediastinal shift to the left. We are describing a missed diagnosis of right CDH in which it was looked for due to the altered texture of the right lung but was not committed as a diagnosis as the suggestive signs were absent. Prenatal diagnosis of variant of hypoplastic left ventricle vs. isomerism with unilateral renal agenesis was made on the basis of abnormal orientation of vessel in the upper abdomen with presence of double vessel sign, azygos continuation to the left superior vena cava, absent stomach bubble, right sided pleural effusion, hypoplasia of the left ventricle and absent right kidney. Postnatal studies disclosed liver and kidney in the chest through a right sided defect with small left heart but not hypoplastic. We conclude that when an abnormal vessel tracing and unexplainable cardiac chamber asymmetry is encountered, right diaphragmatic hernia should be considered as correct recognition and proper neonatal assistance may lead to timely and appropriate management of these fetuses.