Differentiating Imaging Characteristics of Congenital Diaphragmatic Hernia and Diaphragmatic Eventration

Shao-Hua Ji,1 Hong Zhang,1 Zhe Li,2 Su-Li Niu,3 Mei-Rong Han1 1Department of Radiology, Shanxi Children’s Hospital, Women Health Center of Shanxi, Taiyuan, 030001, People’s Republic of China; 2Department of Radiology, Shanxi Second People’s Hospital, Taiyuan, 030002, People’s Republic of China; 3Department of Radiology, Taiyuan Central Hospital, Taiyuan, 030001, People’s Republic of ChinaCorrespondence: Mei-Rong Han, Department of Radiology, Shanxi Children’s Hospital, Women Health Center of Shanxi, Taiyuan, 030002, People’s Republic of China, Tel +86 17835111680, Email [email protected]: Congenital diaphragmatic hernia (CDH) and congenital diaphragmatic eventration (CDE) exhibit overlapping imaging features that can contribute to diagnostic challenges. The aim of this study is to systematically and retrospectively examine the clinical and imaging characteristics of CDH and CDE to delineate their differences in diagnosis, treatment, and prognosis assessment, thereby providing a foundation for evidence-based clinical decision-making.Methods: A retrospective analysis was conducted on 78 cases of CDH and 20 cases of CDE diagnosed between January 2020 and December 2024 at a single institution. Imaging modalities reviewed included chest radiography, gastrointestinal contrast studies, ultrasonography, and computed tomography, in conjunction with clinical data. Key imaging parameters assessed were the integrity of the diaphragmatic contour, diaphragmatic motion, mediastinal displacement, thoracoabdominal organ position, pulmonary development, and amniotic fluid volume.Results: The sensitivity of X-ray and CT was (CDH 97.43% vs 100%, CDE 80.00% vs 90.00%), and the sensitivity of CT was higher than that of X-ray. The examination results were significantly associated with disease classification, which had statistical significance (P < 0.05). In terms of diaphragm integrity and other malformations, CT examination showed significantly higher sensitivity than X-ray examination (100% vs 91.02%,6.41% vs 2.56%). However, in terms of paradoxical movement of the diaphragm, X-ray dynamic examination showed higher sensitivity than CT examination (80.00% vs 0%). Surgical management of CDH was more complex, influenced by the type and extent of the hernia as well as associated anomalies, and often necessitated intensive postoperative care. In contrast, surgical intervention for CDE was less complicated and associated with more favorable outcomes.Conclusion: Despite certain overlapping imaging findings, CDH and CDE present distinct radiologic and clinical profiles. Comprehensive comparative imaging analysis enhances the understanding of their underlying pathophysiological differences, facilitates accurate diagnosis, and supports the development of tailored management strategies to improve clinical outcomes and long-term quality of life.Keywords: congenital diaphragmatic hernia, diagnosis, diaphragmatic eventration, imaging, prognosis