PMC8081028_01
The plain chest x-ray shows an air-fluid level on the left side of the chest with an absent gastric shadow, initially interpreted as hydropneumothorax.
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F1
The x-ray showed an air-fluid level suggesting an encysted hydropneumothorax or pyopneumothorax with a mediastinal shift (Figure 1).
The barium-filled chest x-ray shows the NG tube and the contrast present in the thoracic cavity, indicating a CDH.
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F2
Instead, a barium study was done with an NG tube, which showed a CDH with tension gastrothorax (Figure 2).
The follow-up chest x-ray shows a normal mediastinum with the gastric bubble present below the diaphragm.
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F3
An emergency laparotomy was done, which revealed a left posterolateral diaphragmatic defect through which the stomach, spleen, small bowel loops, and colon herniated into the left thorax (Figure 3). The postoperative x-ray was normal (Figure 3).