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RADIOLOGY: CHEST: Case# 33646: CONGENITAL DIAPHRAGMATIC HERNIA. Neonate. Bubbly opacity is seen over the left hemithorax. There is shift of the mediastinum to the right. Bowel is seen extending up from the abdomen crossing the region of the hemi-diaphragm and ending in the chest. This finding is compatible with a congenital diaphragmatic hernia. Other entities in this differential include a diaphragmatic eventration, a cystic adenomatoid malformation or possibly a congenital lobar emphysema. Those are much less likely given the appearance of the bowel extending across the hemi-diaphragm. Congenital diaphragmatic hernia is, in general, readily repaired surgically. The patients clinical outcome depends on the degree of the associated pulmonary hypoplasia. Congenital diaphragmatic hernia are named based on the location of the diaphragmatic defect. A Bochdalek hernia occurs at the posterior diaphragm and is the most common in a newborn. It is seen approximately five times more frequently on the left than the right.

Peter Anderson