In two separate incidents, two toddlers with no previous history of re
spiratory ailments presented to the emergency department of a children
's hospital with progressive respiratory distress. Both children had u
nilateral lung findings on auscultation and initial chest radiographs
that were consistent with a pneumothorax. Thoracostomy and chest tube
insertion were performed during initial resuscitation efforts. In both
cases, subsequent radiographs revealed that the stomach was located i
n the left hemithorax, suggestive of a diaphragmatic hernia. Nasogastr
ic tube insertion relieved the respiratory distress of these two child
ren. Recognition of the ''acquired'' congenital diaphragmatic hernia i
n the setting of extreme aerophagia or mild abdominal trauma may preve
nt unnecessary procedures during the resuscitation of children with ac
ute respiratory distress and unilateral lung findings.