Pathological Findings in Congenital Diaphragmatic Hernia on necropsy
studies: A Single-Center Case Series
Abstract
Introduction: Congenital diaphragmatic hernia (CDH) is known with high
mortality rates and significant pulmonary morbidities. The objective of
this study was to describe the histopathological findings of necropsy
and clinical manifestations in CDH patients to find the
clinicopathological correlations. Methods: We reviewed the postmortem
findings with associated clinical characteristics retrospectively in 8
CDH cases from 2017 to2022 July. Results: Of the eight cases, one was
bilateral congenital eventration diagnosed by autopsy. Severe pulmonary
hypertension with a right to left shunting of large patent ductus
arteriosus (PDA) obtained from echocardiogram were most common. And the
average time of survive was 46 (8-624) h. According to the autopsy
reports, the major pathological lung changes were diffuse alveolar
damages (congestion and hemorrhage) and hyaline membrane formation.
Notably, although the lung volume was significantly reduced, pulmonary
structural dysplasia was not observed at all, presented normal lung
development (50%); bilateral (25%) or ipsilateral (25%). Lobulated
deformities were accompanied in three (37.5%) cases. All patients
exhibited large PDA and a patent foramen ovale with increased right
ventricle (RV) volume, and the myocardial fibers were slightly congested
and swollen. Pulmonary vessels showed mild to moderate arterial media
thickening. Lung hypoplasia and diffuse lung damages reduced gas
exchange, meanwhile the PDA and PH caused RV failure, contributed a
clinical picture of organ dysfunction, which lead to death. Conclusions:
Pulmonary structures have certain heterogeneity in CDH. The arteries’
pathological changes are not consistent with clinical diagnosis. And the
adverse outcome may should be due to the cardiopulmonary vicious cycle.