Multiple cystic air filled lesions in the chest presenting as respiratory distress in a neonate

A neonate presents with respiratory distress, contralateral mediastinal shift and multiple cystic air filled lesions in the chest. Most likely diagnosis is:

A. Congenital diaphragmatic hernia
B. Congenital lung cysts
C. Pneumonia
D. None of the above

Answer is A. Congenital diaphragmatic hernia.

A case of diaphragmatic hernia typically presents with:

• severe respiratory distress within the first few hours of life or neonatal period
  
• absence of breath sounds and shift of heart sounds signifying mediastinal shift
• accompanied by a scaphoid abdomen in infants.

Chest X-Ray is usually diagnostic of congenital diaphragmatic hernia.

The lateral film shows the intestines passing through the posterior portion of the diaphragm. The swallowed air may manifest as multiple cystic air filled spaces in the chest which is due to the coils of air filled small bowel loops.