Late presentation of Bochdalek hernia: Clinical and radiological aspects

Three infants with late presentation of Bochdalek hernia are presented. The presenting symptoms were cough, intermittent vomiting, dyspnea, and cyanos is. Initial diagnoses of isolated paravertebral mass and foreign material a spiration were made in two infants, based on plain chest x-ray findings and history of the patients. Further radiological investigations, such as cont rast upper gastrointestinal series or enema, computerized tomography, and m agnetic resonance imaging of the chest, suggested the diagnosis of Bochdale k hernia. The hernia was found on the left side in two patients and on the right side in one. At operation, the stomach, small intestine, and spleen w ere found as herniated organs in one patient, ascending colon in one, and a ll of the small intestine together with ascending colon in the other. A congenital diaphragmatic defect should be suspected in every child presen ting with unusual respiratory or gastrointestinal symptoms and with abnorma l chest x-ray findings. The radiological findings vary greatly from one cas e to another, and even in the same case at different times because of diffe rences in herniated organs and intermittent spontaneous reduction. The poss ibility of congenital diaphragmatic hernia should be kept in mind to avoid a wrong diagnosis. undue delay in diagnosis, and inappropriate treatment. ( C) 2001 Wiley-Liss. Inc.