Presentation
Tachypnea with subcostal recession.
Patient Data
Evidence of a deviated nasogastric tube (NGT) with its tip in the gastric fundus.
Reduced left lung volume with mild elevation of left hemidiaphragm.
An opacity is seen at the left mid-zone.
No pleural effusion.
No cardiomegaly. No mediastinal widening.
The incidental finding of lucency ( part of the stomach) above the level of the hemidiaphragm, left of the midline.
No osseous abnormality.
Presence of nasogastric tube with its tip in stomach.
Part of stomach body herniated through widened esophageal hiatus above the hemidiaphragm level.
Gastric antrum, pylorus, D1 and D2 displaced anteriorly.
D3 is crossing between superior mesenteric vessels and abdominal aorta.
Both hemidiaphragm are intact.
Enlarged anterior mediastinum with soft tissue density lesion in keeping with thymus.
Case Discussion
CXR showed an opacity at the left mid zone, suggestive of congenital neonatal pneumonia, consistent with a clinical history of tachypnea and subcostal recession.
The incidental finding of a lucency (part of the stomach) above the level of the hemidiaphragm suggests a congenital hiatus hernia.
CT confirmed the diagnosis evidenced by herniation of part of the gastric body via the esophageal hiatus.
Differential diagnosis: congenital diaphragmatic hernia.
Even though there is rotation of the patient at the time of exposure, the left-sided NGT deviation alludes to the regional mass effect, likely due to gastric herniation.
The NGT tube should also be more distally inserted as evidenced by the draining orifice in the distal thoracic esophagus.
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