Diagnosis of a Right Congenital Diaphragmatic Hernia in a Neonate with POCUS

Point of care ultrasound (POCUS) can be used to diagnose neonatal lung diseases, especially in the setting of a newborn with significant respiratory distress. A neonate was born at 38.4 weeks gestational age to a 36-year-old Gravida 5 Para 3013 woman with prenatal concerns for fetal cardiothoracic anomalies. Fetal echocardiogram demonstrated left atrial compression of unclear etiology. After delivery, the neonate experienced significant respiratory distress. A transthoracic echocardiogram revealed pulmonary hypertension but no structural heart disease. A lung POCUS exam revealed a homogenous echogenic structure within the right pleural cavity consistent with liver parenchyma. The initial diagnosis of right Congenital Diaphragmatic Hernia (CDH) was made and confirmed by a radiology-performed lung ultrasound and a computed tomography (CT) scan of the chest. This case demonstrated the utility of lung POCUS as an initial diagnostic tool in the neonatal intensive care unit (NICU) for CDH.