A newborn term infant presents with respiratory distress immediately after birth. The heart sounds are shifted to the right hemithorax and bowel sounds are audible in the left chest. A nasogastric tube is curled in the left hemithorax on chest X-ray. The most likely diagnosis is:

• A Left-sided Bochdalek hernia ✓
• B Right-sided Bochdalek hernia
• C Right-sided Morgagni hernia
• D Eventration of the left diaphragm

Explanation

Congenital diaphragmatic hernia most commonly occurs as a left-sided posterolateral (Bochdalek) hernia. The combination of respiratory distress at birth, shifted heart sounds to the opposite side, bowel in the chest, and a curled NG tube in the chest is classic. Bochdalek hernias account for 90 percent of cases and are left-sided in 85 percent. Morgagni hernias are anterior and right-sided, presenting later in childhood. Eventration is a thinning of the diaphragm without a defect.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.