Right congenital diaphragmatic hernia – a diagnosis to consider

Abstract

Objectives. Diaphragmatic hernia is not a common disease. The severity of symptoms may vary depending on the size of defect and the organs involved. A defect on the right side is quite rare. This congenital condition may not be clinically obvious for a long time. Material and method. We present the case of a patient hospitalised in the Pediatrics Department of "Grigore Alexandrescu" Hospital for unrelated pathology, incidentally diagnosed with right congenital diaphragmatic hernia after the age of three. Results (case presentation). 3 years 6 months old girl is admitted for persistent cough. An antenatal diagnosis of agenesis of the aortic arch had been set. She was born premature, required intensive care during the neonatal period, one diagnosis being right pulmonary hemorrhage. Postnatal ultrasound examination diagnosed venous duct anomaly. She had a good clinical course with normal growth, normal cardiac and liver functions. The clinical examination was unremarkable. A thoracic X-ray described homogeneous, well-defined opacity in the right lower pulmonary lobe. Abdominal ultrasound confirmed azygos continuation of the inferior vena cava. She underwent antibiotic therapy for pneumonia (7 days) with no change of the thoracic image. Thoracic computed tomography demonstrated Morgagni's hernia with liver thoracic dislocation. Conclusions. Diaphragmatic hernia is a challenging diagnosis to be made. Although a congenital condition, it may be asymptomatic for a long time and a high degree of suspicion is required.