Artifacts, Pitfalls & Normal Variants

Pseudo-Congenital Diaphragmatic Hernia


 

Stomach appearing to reside within the fetal thorax adjacent to the heart

Stomach normally positioned below the diaphragm (arrows)

Findings:

The image on the left demonstrates the fetal stomach and heart to be at the same "apparent" level and both reside within the thorax. The sagittal plane of section on the right demonstrates that the fetal stomach is normally postioned below the normally curved hemidiaphragm.

Discussion:

This pitfall is created when the plane of section is angled downwards in either a semi-coronal or semi-sagittal plane of section. The clue on the image on the left is that rather than seeing a single set of ribs (as we would expect to see in a true transverse axial plane of section) we are seeing multiple ribs as the plane of section is angled downward across the chest. Of course imaging true coronal or sagittal plane will demonstrate the diaphragm and the normal relationship of the stomach below and the heart above. For more information on this entity, see the discussion of congenital diaphragmatic hernia.

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