Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child:
a case report and review of literatures
Dublin Core
Title
Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child:
a case report and review of literatures
a case report and review of literatures
Subject
Congenital diaphragmatic hernia, Tension pneumothorax, Case report, Surgical repair, Respiratory distress
Description
Abstract
Background Congenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of
abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally
or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension
pneumothorax, complicating diagnosis and management.
Case presentation A two-year old male black child from Ethiopia presented to the emergency department with
sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of
tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion
of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation
of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with
herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After
the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative
recovery was uneventful, and the child was discharged with no significant long-term complications.
Conclusion This case underscores the importance of considering CDH in the differential diagnosis of acute
respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions
based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled
structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised
suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index
of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes.
Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide
symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in
our case.
Keywords Congenital diaphragmatic hernia, Tension pneumothorax, Case report, Surgical repair, Respiratory distress
Background Congenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of
abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally
or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension
pneumothorax, complicating diagnosis and management.
Case presentation A two-year old male black child from Ethiopia presented to the emergency department with
sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of
tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion
of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation
of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with
herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After
the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative
recovery was uneventful, and the child was discharged with no significant long-term complications.
Conclusion This case underscores the importance of considering CDH in the differential diagnosis of acute
respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions
based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled
structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised
suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index
of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes.
Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide
symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in
our case.
Keywords Congenital diaphragmatic hernia, Tension pneumothorax, Case report, Surgical repair, Respiratory distress
Creator
Ashagre Gebremichael1* and Wintana Tesfaye2
Source
https://doi.org/10.1186/s12245-024-00741-y
Date
2024
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Ashagre Gebremichael1* and Wintana Tesfaye2, “Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child:
a case report and review of literatures,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12502.
a case report and review of literatures,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12502.