<prompt> A newborn presented severe respiratory distress. On examination he was found to have scaphoid abdomen and absent breath sounds on left side of chest. The most likely diagnosis is:Transient tachypnea of newbornCongenital adenomatoid lung diseaseCongenital Diaphragmatic herniaSequestration of lung  <response>: Ans: c Congenital Diaphragmatic hernia. Ref: Radiology Review Manual, 5th ed., 478CONGENITAL DIAPHRAGMATIC HERNIA It is most common intrathoracic fetal anomaly due to absence of closure of pleuroperitoneal canal by 9th week of gestation Congenital diaphragmatic hernia occur in two locations:- Posterolateral pleuroperitoneal canal Bochdalek hernia--common- Anteromedial pleuroperitoneal canal Morgagni hernia--rare Left sided Bochdalek hernias are much more frequent than right sided. On USG, congenital diaphragmatic hernia can be detected as early as at 17th week of gestation. Small intestine in 88, stomach in 60, colon in 56, spleen in 45, liver in 51 and kidney in 22 chances of herniation into chest in Bochdalek hernia. Mediastinal deviation is often seen first and is the most obvious USG sign of CDH. Absolute diagnostic sign is visualization of peristalsis in chest and paradoxical motion of the abdominal contents on fetal inspiration.0 In Morgagni hernia, omentum and colon are the most frequent hernial contents. It is known to be associated with trisomy syndromes. Presents as respiratory distress in neonatal period due to life threatening deficiency of small airways and alveoli, and scaphoid abdomen. CXR:- Bowel loops in chest- Contralateral mediastinal shift- Completepartial absence of diaphragm- Absence of stomachsmall bowel in abdomenCongenital cystic adenomatoid lung malformation CCAMCALD It is congenital cystic abnormality of lung characterized by a interlobar mass of disorganized pulmonary tissue Presents with respiratory distress and severe cyanosis in first week of life 66 or within first year of life 90 Equal frequency in all lobes seen Three types are known: microcystic, macrocystic and mixed type. CXR:- Unilateral expansile mass with well-defined margins 80- Multiple airoccasionally fluid-filled- Compression of adjacent lung cysts- Contralateral mediastinal shift 87- Hypoplastic ipsilateral lung- Proper position of abdominal viscera- Spontaneous Pneumothorax late sign 