A chest radiograph of a newborn shows the stomach bubble and bowel loops in the left hemithorax with rightward mediastinal shift. Which diagnosis is most consistent and what radiological sign is classically described?

• A Congenital lobar emphysema — hyperlucent lobe
• B Congenital pulmonary airway malformation — multicystic mass
• C Left pleural effusion — homogeneous opacity with meniscus sign
• D Left-sided congenital diaphragmatic hernia — scaphoid abdomen with absent left dome ✓

Explanation

Congenital diaphragmatic hernia (Bochdalek type, 80% left-sided) shows bowel loops or stomach in the left hemithorax, rightward mediastinal shift, and a classically scaphoid abdomen (paucity of bowel gas below the diaphragm). The absent left hemidiaphragmatic dome is the key plain film finding. CPAM appears as a multicystic lung mass without bowel herniation. Congenital lobar emphysema shows a hyperlucent, hyperexpanded lobe. Pleural effusion would not contain bowel gas shadows.

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

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