A newborn presented severe respiratory distress. On examination he was found to have scaphoid abdomen and absent breath sounds on left side of chest. The most likely diagnosis is:

Ans: c Congenital Diaphragmatic hernia). (Ref: Radiology Review Manual, 5th ed., 478)CONGENITAL DIAPHRAGMATIC HERNIA# It is most common intrathoracic fetal anomaly due to absence of closure of pleuroperitoneal canal by 9th week of gestation# Congenital diaphragmatic hernia occur in two locations:- Posterolateral pleuroperitoneal canal (Bochdalek hernia)--common- Anteromedial pleuroperitoneal canal (Morgagni hernia)--rare# Left sided (Bochdalek) hernias are much more frequent than right sided.# On USG, congenital diaphragmatic hernia can be detected as early as at 17th week of gestation.# Small intestine in 88%, stomach in 60%, colon in 56%, spleen in 45%, liver in 51% and kidney in 22% chances of herniation into chest in Bochdalek hernia.# Mediastinal deviation is often seen first and is the most obvious USG sign of CDH.# Absolute diagnostic sign is visualization of peristalsis in chest and paradoxical motion of the abdominal contents on fetal inspiration.0# In Morgagni hernia, omentum and colon are the most frequent hernial contents. It is known to be associated with trisomy syndromes.# Presents as respiratory distress in neonatal period due to life threatening deficiency of small airways and alveoli, and scaphoid abdomen.# CXR:- Bowel loops in chest- Contralateral mediastinal shift- Complete/partial absence of diaphragm- Absence of stomach/small bowel in abdomenCongenital cystic adenomatoid lung malformation (CCAM/CALD)# It is congenital cystic abnormality of lung characterized by a interlobar mass of disorganized pulmonary tissue# Presents with respiratory distress and severe cyanosis in first week of life (66%) or within first year of life (90%)# Equal frequency in all lobes seen# Three types are known: microcystic, macrocystic and mixed type.# CXR:- Unilateral expansile mass with well-defined margins (80%)- Multiple air/occasionally fluid-filled- Compression of adjacent lung cysts- Contralateral mediastinal shift (87%)- Hypoplastic ipsilateral lung- Proper position of abdominal viscera- Spontaneous Pneumothorax (late sign)