Thorax/Abdomen — MCQs

Q: What is the most common site of congenital diaphragmatic hernia?

Posterolateral. ***Posterolateral*** - The **posterolateral** region, specifically the foramen of Bochdalek, is the most common site for congenital diaphragmatic hernia (CDH). - This type of hernia accounts for approximately 80-90% of all CDH cases and usually occurs on the **left side**. *Central tendon* - Hernias through the **central tendon** are extremely rare and are distinct from the more common forms of CDH. - Defects in the central tendon are often associated with **pericardial defects** rather than typical diaphragmatic hernias which allow abdominal contents into the thoracic cavity. *Crural* - Hernias involving the **crura** of the diaphragm are typically **hiatal hernias** (e.g., sliding or paraesophageal), which are different in origin and presentation from CDH. - These are usually acquired and involve the stomach moving into the mediastinum, rather than a congenital defect leading to abdominal viscera migrating into the chest. *Anterolateral* - While congenital diaphragmatic hernias can occur **anterolaterally** through the foramen of Morgagni, these are much less common than posterolateral hernias. - Morgagni hernias account for a small percentage of CDH cases (around 2-5%) and are typically located on the right side, often containing omentum or colon. *Esophageal hiatus* - The **esophageal hiatus** is the normal opening in the diaphragm through which the esophagus passes. - While hiatal hernias can occur at this site, these are typically **acquired hernias** in adults, not congenital diaphragmatic hernias. - Congenital CDH refers to developmental defects in the diaphragm itself, not enlargement of normal openings.

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