We present a case of congenital diaphragmatic hernia.

Our ultrasound examination at 26 weeks of gestation revealed a left-sided thoracic mass shifting the heart to the right, the heart itself having a normal axis and normal morphology. The mass was hypoechoic with round peripheral hyperechoic borders. On sagittal Doppler images, an arterial vessel supply was seen. Interestingly the stomach was in the abdominal location.

Our differential diagnosis was (1) a mixed congenital pulmonary malformation with both sequestration (due to the vessel) and adenoid macrocystic malformation, or (2) an unusual form of a congenital diaphragmatic hernia as the mass neither appeared to be the usual posterolateral Bochdalek hernia, nor the anteromedial Morgani hernia (since the mass was not located anterior to the pericardium).

We then performed an MRI at 27 weeks of pregnancy which clearly depicted bowel within the thorax due to a lateral diaphragmatic defect (Image 2-5). The stomach in the abdominal cavity. Both small bowel and large intestines were within the hernia defect. The large bowel contained meconium which appeared bright on T1w sequences. The hypoplastic left lung could also be seen in the upper left thorax.

The take-home message of this case is: do not rule out left congenital diaphragmatic hernia only because the stomach is in abdominal location!