A term neonate develops severe respiratory distress within hours of birth. The abdomen is scaphoid, breath sounds are absent on the left side, heart sounds are displaced to the right, and bowel sounds are audible over the left hemithorax. Chest X-ray shows air-filled bowel loops in the left hemithorax with a nasogastric tube coiling within them. The most likely diagnosis is:

• A Left posterolateral diaphragmatic hernia ✓
• B Congenital pulmonary airway malformation
• C Congenital lobar emphysema
• D Left pleural effusion

Explanation

The combination of respiratory distress, a scaphoid abdomen (bowel displaced into the chest), absent breath sounds with audible bowel sounds over the thorax, and bowel loops plus a coiled nasogastric tube in the hemithorax on X-ray is diagnostic of congenital diaphragmatic hernia. About 85 percent are left-sided and posterolateral (Bochdalek). B CPAM would show intrapulmonary cysts, not bowel loops, and a scaphoid abdomen does not occur with any purely thoracic lesion.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.