Presentation
Tachypnea
Patient Data
A chest x-ray demonstrated irregular collections of gas in the right hemithorax with compressive atelectasis of the right lung and some mediastinal shift to the left.
Following contrast, the stomach is demonstrated midline with loops of bowel entering the right hemithorax.
Case Discussion
The differential diagnosis was between congenital diaphragmatic hernia, and congenital cystic adenomatoid malformation (CCAM). Delayed x-ray following administration of contrast via the nasogastric tube shows loops of bowel in the right hemithorax, confirming a right congenital diaphragmatic hernia. Herniation is typically via a posterior defect in the diaphragm (Bochdalek hernia). It occurs more commonly on the left than the right (5:1). They can present at birth with severe respiratory distress, but less severe cases may present later in life or incidentally on radiography. The degree of associated pulmonary hypoplasia is the major factor determining prognosis.
Credit: Bernard Ng, Marina-Portia Anthony