Delayed presentation of congenital diaphragmatic hernia (CDH) is not uncommon and can represent 5-30% of total CDHs.1 Time before the diagnosis may be prolonged, sometimes to the adult period. Respiratory and gastrointestinal symptoms are frequent but not specific. Children presenting with gastrointestinal symptoms have been shown to be significantly older than those presenting with respiratory symptoms.2 Late presentations can be misleading to a clinician. However, when a diagnosis of CDH is established, it must be promptly treated surgically in order to avoid complications such as strangulation or bowel perforation. Outcome is usually favourable after surgery. We hereby report a case of congenital diaphragmatic hernia presenting as acute chest pain due to midgut volvulus in left thoracic cavity. Case Report A previously healthy 14 year old male child was admitted to the hospital with a history of acute pain in the left side of chest and grade 1 dyspnoea for 4 days. Pain was constant, dull aching, more upon deep inspiration. Pain was much severe and was associated with vomiting on the day of admission. There was decreased air entry at the left posterior side of the chest, but no other abnormality on auscultation. The abdomen was scaphoid but non tender. A plain erect chest radiograph (Fig. 1) showed that left dome of diaphragm and left costophrenic angle were obscured by moderate pleural effusion along with loss of left cardiac border silhouette. Mediastinum was displaced to the right. Ultrasonography (USG) of the chest revealed left sided consolidation with mild pleural effusion.
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