A 10-month-old boy was admitted with cough and fever despite a course of oral antibiotics. Oxygen saturation was normal in air. There were reduced breath sounds posteriorly on the left side of the chest, with normal percussion. Bowel sounds were not heard in the chest.Chest radiography (Figure 1) showed an unusual multilocular cystic lesion, suggestive of bowel loops, on the left side of the chest, with lung tissue seen inferiorly and minimal mediastinal deviation to the right. This suggested a left-sided diaphragmatic hernia. Chest computed tomography (Figure 2) revealed a left sided cystic parenchymal lung lesion.Congenital diaphragmatic hernia is being increasingly diagnosed antenatally. Postnatally, it can present with respiratory distress, a scaphoid abdomen, bowel sounds in the chest and abnormal chest radiograph. It occasionally presents in childhood with respiratory or abdominal symptoms. 1 The differential diagnosis includes congenital cystic adenomatoid malformation, bronchogenic cyst, pulmonary sequestration, or necrotizing staphylococcal pneumonia. Congenital thoracic malformations are usually smaller with later presen-Data sharing statement available at www.jpeds.com.
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