Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 23 peer-reviewed journal articles Updated
Maternal-Fetal Medicine

Left vs. Right-Sided CDH: What Are the Differences?

At a Glance

Left-sided CDH is more common (85% of cases) and typically involves the stomach and intestines moving into the chest. Right-sided CDH is rarer, often involves larger defects, and frequently causes the liver to herniate into the chest, which takes up more space and restricts lung growth.

In this answer

4 sections

01

How Common Is Each Type?

02

Which Organs Move Into the Chest?

03

Is One Side More Severe Than the Other?

04

Fetal and Postnatal Treatment

When your baby is diagnosed with congenital diaphragmatic hernia (CDH), one of the first things your doctor will tell you is whether the hole in the diaphragm is on the left side or the right side. The majority of CDH cases are left-sided, which is why most of the information you find online focuses on that type. However, whether the hernia is on the left or the right does matter, as it affects which organs move into the chest, the typical size of the hole, and how your baby’s condition may be managed.

How Common Is Each Type?

The vast majority of congenital diaphragmatic hernias—about 84% to 85%—occur on the left side [1]. Right-sided CDH is much less common, accounting for roughly 15% to 16% of cases [1]. Both left- and right-sided hernias are typically Bochdalek hernias, which means the hole is located toward the back and side of the diaphragm [2][3]. Rarely, a baby might have a Morgagni hernia, which is a hole near the front and center of the diaphragm, but these are less common and behave differently.

Which Organs Move Into the Chest?

Because the anatomy of the abdomen is different on the left and right sides, the organs that shift into the baby’s chest (herniate) depend on where the hole is. This displacement of organs compresses the developing lungs and contributes to pulmonary hypoplasia (underdeveloped lungs) and pulmonary hypertension (high blood pressure in the lungs), which are the main challenges in CDH [4][5].

To predict severity, doctors measure your baby’s lung size using a metric called the observed-to-expected lung-to-head ratio (O/E LHR) or via fetal MRI [6][7].

  • Left-Sided CDH (LCDH): The stomach, intestines, and spleen are the organs most likely to move into the chest. In left-sided CDH, doctors pay close attention to whether the stomach has moved up (“stomach-up”) or stayed in the abdomen (“stomach-down”). A stomach that remains in the abdomen is generally associated with fewer complications [8]. The liver can also sometimes move up into the chest in left-sided cases [6].
  • Right-Sided CDH (RCDH): The liver and gallbladder naturally sit on the right side of the abdomen. Therefore, in right-sided CDH, the liver is the main organ that moves into the chest, often along with the intestines [2][3][9]. In rare instances, right-sided CDH can involve the liver fusing with the lung tissue (hepatopulmonary fusion) [10][11].

The Impact of the Liver

Whether the hernia is on the left or the right, liver herniation (often called “liver-up”) is one of the most important factors doctors use to predict how severe the CDH will be [6][12]. Because the liver is a large, solid organ, it takes up more space in the chest and causes more compression on the growing lungs than hollow organs like the stomach or intestines [4][13]. Because the liver is located on the right, right-sided CDH very frequently involves liver herniation [9][4].

Is One Side More Severe Than the Other?

Historically, right-sided CDH was thought to have a worse prognosis than left-sided CDH. However, recent research shows a more nuanced picture. Please note: Reading survival statistics can be incredibly stressful and scary. Keep in mind that every baby’s case is unique, and these numbers represent broad averages, not your baby’s specific outlook.

  • Defect Size: Right-sided CDH cases often have larger holes (defects) in the diaphragm compared to left-sided cases [1]. Larger defects are associated with a lower survival rate and a higher need for specialized life support after birth, such as extracorporeal membrane oxygenation (ECMO), a machine that acts as an artificial heart and lungs [14][15].
  • Survival Rates: When researchers compare babies with the exact same size of diaphragmatic hole, the survival rates between right-sided and left-sided CDH are actually very similar [1][16][17]. The overall survival rate in large registries is about 67% for right-sided and 72% for left-sided, reflecting the fact that right-sided hernias tend to be larger [1].
  • Long-Term Outcomes: Some studies suggest that babies with right-sided CDH may experience slightly more long-term health challenges (morbidity) than those with left-sided CDH, highlighting the need for specialized, long-term follow-up care [18][19].

Fetal and Postnatal Treatment

For very severe cases of CDH, a fetal surgery called FETO (fetal endoscopic tracheal occlusion) may be offered before birth. This procedure involves placing a tiny balloon in the unborn baby’s airway to help the lungs grow. FETO has been shown to improve survival for severe left-sided CDH [20][21]. While it is sometimes used for right-sided CDH and has shown potential to increase survival in those cases [22], its exact role and effectiveness for right-sided hernias are still being actively studied [20][23].

It is important to remember that prenatal treatments like FETO only help the lungs grow. After birth, all babies with CDH will require immediate intensive care (NICU) to help them breathe, followed by a postnatal surgery to actually move the organs back into the abdomen and close the hole in the diaphragm.

Common questions in this guide

Are left-sided or right-sided diaphragmatic hernias more common?
Left-sided congenital diaphragmatic hernias are much more common, making up about 85% of all cases. Right-sided hernias are rare and account for roughly 15% to 16% of diagnoses.
Which organs move into the chest in left-sided CDH?
In left-sided CDH, the stomach, intestines, and spleen are most likely to move into the chest. Doctors will closely monitor if the stomach has moved up or stayed in the abdomen, as a stomach that stays down generally means fewer complications.
Why is right-sided CDH sometimes considered more severe?
Right-sided CDH often involves larger holes in the diaphragm, which can lead to a higher need for specialized life support like ECMO after birth. Additionally, the liver almost always moves into the chest in right-sided cases, taking up significant space and compressing the developing lungs.
What does "liver-up" mean for my baby's CDH prognosis?
"Liver-up" means the liver has moved through the hole in the diaphragm and into the baby's chest. Because the liver is a large, solid organ, it causes more lung compression than hollow organs, making it a key factor doctors use to predict the severity of the condition.
Can FETO surgery be used for both left and right-sided CDH?
FETO is an established prenatal procedure that can improve survival for severe left-sided CDH by helping the lungs grow. While it is sometimes used for right-sided cases, its exact effectiveness for right-sided hernias is still being actively researched.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the ultrasound and MRI, what size is the defect in my baby's diaphragm?
  2. 2.What is my baby's observed-to-expected lung-to-head ratio (O/E LHR) and what does that mean for their severity?
  3. 3.Which specific organs have moved into my baby's chest, and is the liver 'up' or 'down'?
  4. 4.Does the side of the hernia change the options we have for prenatal treatments, like FETO?
  5. 5.How does the laterality of the hernia affect your specific plan for my baby's delivery and immediate postnatal NICU care?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Why Do CDH Survivors Need Multidisciplinary Clinics?Why Does CDH Cause Severe GERD and Feeding Issues?Will My Baby Outgrow Their CDH Patch? Risks & MonitoringCan CDH Surgery Be Done While on ECMO?What is the FETO Procedure Timeline for CDH?What is Gentle Ventilation for CDH?How Does Congenital Diaphragmatic Hernia Affect Lungs?CDH Liver Up vs Liver Down: What Does It Mean?Will My CDH Child Have Asthma or Need Oxygen?What Are the Prenatal Genetic Testing Options for CDH?How is Pulmonary Hypertension Treated in CDH Babies?Does CDH Affect Your Child's Chest & Spine Growth?What Causes CDH? Did I Cause My Baby's Hernia?What Happens in the Delivery Room with a CDH Baby?What to Expect When Your Baby is on ECMO for CDHWhy is CDH Surgery Delayed? The Role of Stabilization

References

References (23)
  1. 1

    Right versus left congenital diaphragmatic hernia - What's the difference?

    Burgos CM, Frenckner B, Luco M, et al.

    Journal of pediatric surgery 2017; doi:10.1016/j.jpedsurg.2017.10.027.

    PMID: 29122292
  2. 2

    Surgical management of symptomatic right-sided Bochdalek hernias in adults: when is a minimally invasive approach appropriate?

    Lau NS, Crawford M, Sandroussi C

    ANZ journal of surgery 2020; (90(6)):1075-1079 doi:10.1111/ans.15830.

    PMID: 32175658
  3. 3

    Thoracic kidney nephrectomy due to recurrent Bochdalek hernia in an adult.

    Sanz Del Pozo M, García de Jalón Martínez Á, Ordóñez Lozano PA, Sánchez Zalabardo JM

    Cirugia espanola 2023; (101(3)):208-212 doi:10.1016/j.cireng.2022.06.049.

    PMID: 35792247
  4. 4

    Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives.

    Baschat AA, Desiraju S, Bernier ML, et al.

    Translational pediatrics 2024; (13(4)):643-662 doi:10.21037/tp-23-602.

    PMID: 38715680
  5. 5

    Genetic profile of isolated congenital diaphragmatic hernia revealed by targeted next-generation sequencing.

    Kammoun M, Souche E, Brady P, et al.

    Prenatal diagnosis 2018; (38(9)):654-663 doi:10.1002/pd.5327.

    PMID: 29966037
  6. 6

    The diagnostic and predictive value of ultrasonography in congenital diaphragmatic hernia.

    Liu Q, Ren H, Wang M, et al.

    Frontiers in pediatrics 2025; (13()):1726224 doi:10.3389/fped.2025.1726224.

    PMID: 41660394
  7. 7

    Comparison of prenatal lung volume measurements associated with extracorporeal membrane oxygenation (ECMO) utilization and mortality in congenital diaphragmatic hernia.

    Stanic P, Gavulic A, Jenkins TM, et al.

    Journal of pediatric surgery 2026; (61(5)):162970 doi:10.1016/j.jpedsurg.2026.162970.

    PMID: 41619847
  8. 8

    Prenatal ultrasound diagnosis of 'stomach-down' left congenital diaphragmatic hernia.

    Aiello H, Meller C, Vázquez L, Otaño L

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2021; (58(5)):787 doi:10.1002/uog.24779.

    PMID: 34724266
  9. 9

    Genetic burden and multidimensional predictors in prenatal diagnosis of fetal congenital diaphragmatic hernia.

    Huang R, Fu F, Mei S, et al.

    Human genetics 2025; (144(9-10)):1035-1050 doi:10.1007/s00439-025-02777-3.

    PMID: 40913717
  10. 10

    Hepatopulmonary fusion associated with right-sided congenital diaphragmatic hernia: management of this rare anomaly and a review of the literature.

    Almaramhy HH

    The Journal of international medical research 2018; (46(12)):5278-5284 doi:10.1177/0300060518759892.

    PMID: 30352531
  11. 11

    A rare case of hepatopulmonary fusion associated with a right congenital diaphragmatic hernia: Case report and review of the literature.

    Alomar K, Alghazal LK, Alloun M, et al.

    International journal of surgery case reports 2023; (111()):108845 doi:10.1016/j.ijscr.2023.108845.

    PMID: 37741077
  12. 12

    A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry.

    Cruz-Martínez R, Etchegaray A, Molina-Giraldo S, et al.

    Prenatal diagnosis 2019; (39(7)):519-526 doi:10.1002/pd.5458.

    PMID: 30980408
  13. 13

    Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia.

    Grover TR, Rintoul NE, Hedrick HL

    Seminars in perinatology 2018; (42(2)):96-103 doi:10.1053/j.semperi.2017.12.005.

    PMID: 29338874
  14. 14

    Recurrence in congenital diaphragmatic hernia: A multicenter, postdischarge pilot study.

    Gupta VS, Holden KI, Chiu PP, et al.

    Surgery 2025; (181()):109209 doi:10.1016/j.surg.2025.109209.

    PMID: 39978174
  15. 15

    Correlation of MRI Brain Injury Findings with Neonatal Clinical Factors in Infants with Congenital Diaphragmatic Hernia.

    Radhakrishnan R, Merhar S, Meinzen-Derr J, et al.

    AJNR. American journal of neuroradiology 2016; (37(9)):1745-51 doi:10.3174/ajnr.A4787.

    PMID: 27151752
  16. 16

    Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

    Sperling JD, Sparks TN, Berger VK, et al.

    American journal of perinatology 2018; (35(10)):919-924 doi:10.1055/s-0037-1617754.

    PMID: 29304545
  17. 17

    Clinical characteristics and outcomes of the right congenital diaphragmatic hernia compared to the left: a 10-year single-center experience.

    Okamoto M, Amano H, Uchida H, et al.

    Pediatric surgery international 2021; (37(12)):1675-1681 doi:10.1007/s00383-021-04999-8.

    PMID: 34436672
  18. 18

    Outcomes of infants with congenital diaphragmatic hernia by side of defect in the FETO era.

    Ali K, Dassios T, Khaliq SA, et al.

    Pediatric surgery international 2019; (35(7)):743-747 doi:10.1007/s00383-019-04484-3.

    PMID: 31089883
  19. 19

    Hepatopulmonary fusion in congenital diaphragmatic hernia: successful management of a lethal variant.

    Menon R, Saxena R, Pathak M, Yadav T

    BMJ case reports 2024; (17(6)) doi:10.1136/bcr-2024-260486.

    PMID: 38926130
  20. 20

    Prenatal Diagnosis, In Utero Management, and Perinatal Outcomes of Congenital Diaphragmatic Hernia.

    LeMoine FV, Backley S, Hernandez-Andrade E, et al.

    Clinical obstetrics and gynecology 2025; (68(3)):387-398 doi:10.1097/GRF.0000000000000946.

    PMID: 40296256
  21. 21

    Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis.

    Provinciatto H, Barbalho ME, Araujo Júnior E, et al.

    Journal of clinical medicine 2024; (13(12)) doi:10.3390/jcm13123572.

    PMID: 38930102
  22. 22

    Right-sided congenital diaphragmatic hernia in a decade of fetal surgery.

    DeKoninck P, Gomez O, Sandaite I, et al.

    BJOG : an international journal of obstetrics and gynaecology 2015; (122(7)):940-6 doi:10.1111/1471-0528.13065.

    PMID: 25227954
  23. 23

    Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia.

    Van der Veeken L, Russo FM, De Catte L, et al.

    Gynecological surgery 2018; (15(1)):9 doi:10.1186/s10397-018-1041-9.

    PMID: 29770109

This page explains the differences between left- and right-sided CDH for educational purposes. Always consult your maternal-fetal medicine specialist or pediatric surgeon regarding your baby's specific ultrasound findings, diagnosis, and care plan.

Get notified when new evidence is published on Congenital diaphragmatic hernia.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.