TITLE:
A Diagnostic Dilemma: Congenital Diaphragmatic Hernia versus Diaphragmatic Eventration in a Neonate—A Case Report
AUTHORS:
Ezioma Anne Alinnor, Idorenyin Diamond, Chioma Ada Nnah, Kelechi Cynthia Nwokoro
KEYWORDS:
Congenital Diaphragmatic Eventration, Congenital Diaphragmatic Hernia, Neonatal Respiratory Distress, Diaphragmatic Plication, Diagnostic Imaging, Low-Resource Settings
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.16 No.4,
July
6,
2026
ABSTRACT: Background: Congenital diaphragmatic anomalies encompass a spectrum of developmental defects, with congenital diaphragmatic hernia (CDH) and congenital diaphragmatic eventration (CDE) representing the most clinically significant variants. These diaphragmatic abnormalities may present with neonatal respiratory distress, intrathoracic abdominal viscera, and mediastinal shift. While CDH involves a true diaphragmatic defect with herniation of abdominal organs into the thorax, CDE is characterized by an intact but thinned, elevated diaphragmatic sheet. Preoperative differentiation remains challenging, particularly in settings lacking advanced imaging modalities. Case Presentation: We report a male infant referred with progressive respiratory distress and cyanosis from birth. Initial chest radiography revealed gas-filled bowel loops in the left hemi-thorax with mediastinal shift, prompting a presumptive CDH diagnosis. Computed tomography demonstrated elevation of the left hemidiaphragm with intrathoracic stomach and bowel loops and right-ward mediastinal shift. Although diaphragmatic continuity was suggested on imaging, the distinction between CDH and CDE remained uncertain preoperatively. Exploration thoracotomy at 8 weeks demonstrated an intact, diffusely elevated, thinned left hemidiaphragm without a true diaphragmatic defect, confirming CDE. Diaphragmatic plication was performed, with satisfactory clinical improvement. Conclusion: This case reveals the overlap between CDH and CDE and the importance of multimodal imaging, including dynamic ultrasonography when available, to enhance diagnostic accuracy. In settings where advanced imaging is unavailable, or inconclusive, operative findings may establish the diagnosis when surgery is clinically indicated.