On a chest X-ray of a neonate, there is a large opacity in the left hemithorax with mediastinal shift to the right, absence of a gastric bubble below the diaphragm, and bowel loops visible in the left chest. The most likely diagnosis is:

• A Congenital pulmonary airway malformation (CPAM)
• B Congenital lobar emphysema
• C Scimitar syndrome
• D Congenital diaphragmatic hernia (CDH) ✓

Explanation

The triad of bowel loops in the chest, mediastinal shift contralaterally, and absent gastric bubble is characteristic of left-sided Bochdalek congenital diaphragmatic hernia (CDH). CPAM appears as multicystic or solid lung lesion. Congenital lobar emphysema shows hyperinflated lobe without bowel herniation. Scimitar syndrome is characterised by anomalous pulmonary venous return (scimitar vein) with small right lung, not bowel in chest.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.