DIAPHRAGMATIC-HERNIA MASQUERADING AS PNEUMOTHORAX IN 2 TODDLERS

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.