Diaphragmatic Hernia
Congenital diaphragmatic hernia almost always is due to a posterolateral defect of the diaphragm, which results from the persistence of the pleuroperitonal canal on foramen of Bochdalek. The hernia usually is on the left side. Displacement of abdominal organs, including bowel, liver, and/or spleen, into the chest results in mediastinal shift toward the opposite side and in homolateral or bilateral lung hypoplasia.
In patients who have congenital diaphragmatic hernia, oxygenation in the neonatal period may be limited by severe lung hypoplasia as well as by pulmonary hypertension, which may result from decreased pulmonary vascular bed, pulmonary arteriolar muscular hypertrophy, and increased thromboxane production.
