Diaphragmatic Hernia Differential Diagnosis Table

Diaphragmatic Hernia Differential Diagnosis Table:

During the first weeks of gestation, the thoracic and abdominal cavities communicate freely; this is until week 12 of gestation when the intestines move into the abdominal cavity since there is enough space for them now. After this, the thoracic and abdominal cavities are separated. When this displacement of the proper organs does not occur and both of the cavities are not closed, this is called a congenital hernia of the diaphragm.

This condition is congenital; however, the symptoms can occur at any age. It is more common in males.

This condition is of idiopathic origin; however, some authors consider that its origin is multifactorial and some genetic factors can play a very important role in it.

The diaphragm is the main muscle of inspiration and is finished forming around 12 weeks of gestation. In patients with congenital diaphragmatic hernia, this weakness of the wall allows the entry of abdominal organs into the thoracic cavity which prevents normal pulmonary development; this is known as pulmonary hypoplasia. Pulmonary hypoplasia can compromise not only the lung on the defect side but also on the opposite side since the intestines produce a displacement of the mediastinum and compress the structures of the side that is not affected.

On physical examination, patients present an excavated abdomen; this is due to the displacement of the intestinal content through the muscular defect of the diaphragm, causing dyspnea and decreased pulmonary murmurs in the affected hemithorax as well as herniation of the abdominal organs. This diaphragmatic hernia can occur on the left and right sides; when it occurs on the left side, heartbeats can be auscultated on the right side, this is because the mediastinum is displaced causing displacement of the heart as well.

Because patients present with pulmonary hypoplasia, they will present variability in pulmonary arterial pressures as well as changes in the right-left short circuit, which will be translated as hypoxia and acidosis.

How to Distinguish Diaphragmatic Hernia from Other Diseases

Distinguish Diaphragmatic Hernia from Pneumonia – Diagnosis

Pneumonia is an infection of the lung caused by bacteria, fungi, or viruses.

• Diaphragmatic hernia is a congenital defect while Pneumonia is an infection with an incubation period of 2-3 days; in other words, after this period, you will present your symptoms.
• Pneumonia presents dry or productive cough, joint and muscle aches, headache, fever, and general discomfort while Diaphragmatic hernia presents pulmonary hypoplasia, hypoxia, acidosis, excavated thorax, dyspnea, tachypnea, and tachycardia.
• Bacterial Pneumonia can be prevented with a vaccine while Diaphragmatic hernia cannot be prevented.
• Diaphragmatic hernia’s treatment is surgery while Pneumonia does not require surgical intervention since it is treated with antibiotic therapy.

Distinguish Diaphragmatic Hernia from Gastroesophageal Reflux Disease (GERD) – Diagnosis

This condition occurs when the acidic content of the stomach returns to the esophagus.

• Hernia from Gastroesophageal Reflux Disease, unlike Diaphragmatic hernia, causes pain while swallowing, hoarseness, and heartburn.
• Hernia from Gastroesophageal Reflux Disease cause could be due to the weakness of the esophageal sphincter or also as other factors such as: hiatal hernia, pregnancy, obesity, smoking, use of benzodiazepines, calcium channel antagonists, and antidepressants while Diaphragmatic hernia etiology is idiopathic.

Distinguish Diaphragmatic Hernia from Atelectasis – Diagnosis

Atelectasis is a loss of volume in some portion of the lung.

• Atelectasis, unlike Diaphragmatic hernia, can be acquired by different mechanisms of the body.
• Although atelectasis shares radiological signs with Diaphragmatic hernia such as: elevation of the compromised hemidiaphragm and mediastinal displacement, there are some radiological signs of atelectasis that do not occur in diaphragmatic hernias such as: cisural and hilar displacements, and also loss of aeration.

Distinguish Diaphragmatic Hernia from Congenital Heart Defects – Diagnosis

Congenital Heart Defects are a group of diseases that occur when the heart and blood vessels belonging to it do not develop during the gestation period.

• Unlike Diaphragmatic hernia, some congenital heart defects are the result of alcohol or drug use during pregnancy.
• Congenital Heart Defects constitute a series of symptoms that patients with Diaphragmatic hernia do not present such as: blow in the heart, arrhythmias, edema, blue lips, or nails.

Distinguish Diaphragmatic Hernia from Choanal Atresia – Diagnosis

Choanal Atresia is a condition where there is narrowing in the back of the nasal cavity by nasal tissue.

• Choanal Atresia, unlike Diaphragmatic hernia, affects females more than males.
• Both patients with Choanal Atresia and Diaphragmatic hernia have dyspnea, the difference is that patients with Choanal Atresia are relieved from this respiratory picture when they cry.
• Choanal Atresia patients, unlike Diaphragmatic hernia, present a runny nose, noisy breathing, and difficulty feeding them.

Distinguish Diaphragmatic Hernia from Pulmonary Hypoplasia – Diagnosis

Pulmonary Hypoplasia is a congenital anomaly in which lung development is stopped, resulting in deficient development of it.

• Pulmonary Hypoplasia, unlike Diaphragmatic hernia, presents pulmonary hypertension and pulmonary hemorrhage.
• Pulmonary Hypoplasia, unlike Diaphragmatic hernia, is associated with kidney and skeletal diseases.

Common Red Flags with Diaphragmatic Hernia

Many years ago, Diaphragmatic hernia was considered a pediatric emergency. Today, it is only sought to stabilize the patient before evaluating and planning any surgical intervention.
Surgical treatment consists of the reduction of the abdominal viscera and the closure of the diaphragm by suture.
This condition has a good prognosis, especially if the patient does not have other alterations such as Pulmonary Hypoplasia.
Among the complications that this condition can present, the most important ones are: recurrent infections, heart diseases, intestinal or hepatic diseases, changes in the vertebral column.