THE USE OF SALINE SOLUTION AS A CONTRAST-MEDIUM IN SUSPECTED DIAPHRAGMATIC-HERNIA AND RENAL AGENESIS

OBJECTIVE: Our purpose was to determine the value of saline solution i nstillation as a contrast medium in suspected congenital diaphragmatic hernia and renal agenesis. STUDY DESIGN: Intrathoracic (n = 3) or int raperitoneal (n = 2) instillation was performed in five cases of suspe cted congenital diaphragmatic hernia. Amnioinfusion combined with intr aperitoneal instillation was performed in five cases of suspected rena l agenesis. RESULTS: Instillation clearly demonstrated the diaphragmat ic defect in four of the five cases. In the cases with suspected renal agenesis, amnioinfusion led to recognition of a previously unsuspecte d sirenomelia, and intraperitoneal instillation demonstrated empty ren al fossae in four cases. The final fetus with bilateral renal agenesis was thought antenatally to have a contralateral multicystic kidney. C ONCLUSIONS: We suggest that intrathoracic or intraperitoneal saline so lution instillation is a useful diagnostic procedure in carefully sele cted cases where confident ultrasonic diagnosis is often difficult and yet would significantly alter management. In cases of severe oligohyd ramnios amnioinfusion is a complementary procedure. In 80% of cases in this series there was significant improvement in visualization after the procedure.