Horizontal stomach: a new sonographic clue to the antenatal diagnosis of right-sided congenital diaphragmatic hernia.

We report on two cases of isolated right-sided congenital diaphragmatic hernia (CDH) in which the condition was first suspected due to ultrasound visualization of a horizontal orientation of the fetal stomach in the abdomen. In the first case, a 38-year-old woman, gravida 2 para 1, attended the ultrasound department of Valduce Hospital, Como at 13 weeks’ gestation for a first-trimester scan. Fetal nuchal translucency thickness and anatomy appeared normal; however, an abnormal horizontal orientation of the fetal stomach was noted (Figure 1). At 20 weeks’ gestation, a massive protrusion of the liver into the fetal chest was documented, leading to the diagnosis of isolated right-sided CDH. Moderate lung hypoplasia was demonstrated (observed to expected lungto- head ratio was 41%, according to the longest diameter method)1. Antenatal findings were confirmed after birth and neonatal death occurred soon after delivery.