On a neonatal chest X-ray, the trachea is deviated to the right and a gas-filled structure is visible in the left hemithorax displacing the heart. The abdomen appears gasless. What is the most likely diagnosis?

• A Left-sided pleural effusion
• B Cystic adenomatoid malformation (CPAM)
• C Lobar emphysema
• D Congenital diaphragmatic hernia (Bochdalek type) ✓

Explanation

Congenital diaphragmatic hernia (CDH), most commonly Bochdalek type (90%, left-sided, posterolateral), presents with bowel loops in the thorax, mediastinal shift, and a scaphoid/gasless abdomen (bowel displaced into chest). On CXR, gas-filled loops of bowel in the hemithorax with contralateral mediastinal shift and absent bowel gas in the abdomen are classic. CPAM shows cystic lesions but the abdomen has normal bowel gas. Lobar emphysema shows hyperlucent overinflated lobe with no bowel gas in chest.

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

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Written and medically reviewed by the StethoPrep medical team.