Congenital Diaphragmatic Hernia

This 2 month old male baby presented with tachypnoea. A chest X-ray demonstrates irregular collections of air in the right hemithorax with compressive atelectasis of the right lung and some mediastinal shift to the left (note nasogastric tube deviates to the left). 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.
Reference: Donnelly et al. Pocket Radiologist: Pediatrics. 100 Top Diagnoses. Amirsys 2002
Credit: Dr Bernard Ng, Marina-Portia Anthony
http://www.radpod.org