A mother is holding her newborn baby in the hospital bed just a few hours after giving bih. The mother becomes alarmed when her baby begins to have a difficulty in breathing and she rings for help. You arrive at the bedside and observe that the baby is in severe respiratory distress. A quick physical examination reveals that the baby has a barrel-shaped chest, a scaphoid-shaped abdomen, and absence of breath sounds on the left side. A chest radiograph reveals air/fluid containing bowel in the left-side hemithorax, no visible aerated lung on the left side, contralateral displacement of the hea and other mediastinal structures, compression of the contralateral lung, and reduced size of the abdomen. Which of the following is the most likely diagnosis?
High-Yield Explanation
This is a case of Congenital Diaphragmatic (Bochdalek) Hernia. Herniation of abdominal contents into the pleural cavity (usually left). Caused by a failure of the pleuroperitoneal membrane to develop or fuse with other components of the diaphragm. Affected neonates usually present in the first few hours of life with respiratory distress that may be mild or so severe as to be incompatible with life. Symptoms : Difficulty in breathing (neo-natal emergency) O/E -Barrel-shaped chest, Scaphoid-shaped abdomen, and absence of breath sounds on the left side CXR -Air/fluid containing bowel in the left-side hemithorax