Grade IV hiatal hernia in a neonate: A radiologic mimic of congenital diaphragmatic hernia

Congenital hiatal hernia is a rare condition in neonates, often presenting with respiratory distress and mimicking other thoracic or diaphragmatic anomalies such as congenital diaphragmatic hernia. In this report, an 8-day-old female neonate was initially suspected of having congenital diaphragmatic hernia based on imaging studies but was ultimately diagnosed with a Grade IV congenital hiatal hernia. Surgical exploration revealed significant herniation of abdominal organs into the thoracic cavity without diaphragmatic defects, confirming the diagnosis. Multiple diagnostic modalities, including barium swallow radiography and computed tomography, were pivotal in identifying the condition, emphasizing their utility in distinguishing hiatal hernias from other mediastinal pathologies. Comprehensive surgical management, including reduction of herniated contents and Nissen fundoplication, effectively addressed the hernia and its complications. The case illustrates the variability in clinical presentation and diagnostic challenges associated with hiatal hernias, highlighting the importance of tailored approaches for diagnosis and treatment.