Late Presenting Congenital Diaphragmatic Hernia Misdiagnosed as Pneumothorax: A Case Report

Background: Late presentation of Congenital Diaphragmatic Hernia (CDH) is a herniation of abdominal contents through a diaphragmatic defect into the thoracic cavity and diagnosed after the neonatal period. The reported case is a left-sided congenital diaphragmatic hernia, diagnosed as pneumonia and seen as a pneumothorax on a chest radiograph.Case presentation: This is a seven-month-old female child who presented in the emergency department with fever and shortness of breath of four days' duration. Chest x-ray was suggestive of left pneumothorax with left mid-zone consolidation. Chest tube insertion was initially planned. While noticing clear localized air inferiorly with an indistinct left diaphragm, a late diaphragmatic hernia was suspected, and chest tube insertion was not done. A nasogastric tube was swallowed, and a chest radiograph was taken. The x-ray revealed the gastric tube in the left thorax. Surgical repair was carried out after resolution of the infection. The postoperative period was uneventful, and the patient was discharged from hospital after six days. At one month of follow-up visit, the patient was stable, and recovery was satisfactory. Conclusion: This case characterized the clinical manifestation and diagnostic delay of the patient. Early diagnosis and avoiding inappropriate treatment decreases morbidity and mortality. Late presentation of diaphragmatic hernia, although uncommon, needs to be considered in a child with respiratory distress and in unusual patient presentations.