Right-sided congenital diaphragmatic hernia masquerading as complicated pneumonia in a young child

Abstract

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly that is more common on the left side. The right-sided CDH is less common and often missed. Here, we report an infant with right-sided CDH manifesting as complicated pneumonia. A 4-month-old girl presented with fever and fast breathing for the past 4 weeks. It was associated with chest retraction and nonbilious vomiting. On examination, the child had tachypnea, decreased air entry in the right mammary, inframammary, infra-axillary, and infrascapular regions, and fine crepitation was heard in the same areas. Other systemic examinations were normal. Chest X-ray showed heterogeneous opacities with cystic lesions in the right middle and lower lobe. Contrast-enhanced computed tomography thorax revealed a right posterolateral diaphragmatic defect containing the small bowel and right colon. The defect was successfully repaired with thoracoscopic surgery. A possibility of right-sided CDH should be kept in a child with complicated or persistent pneumonia on the right side, especially when associated with vomiting and having a poor response to adequate therapy.