The chest x-ray shows following findings.

• Bowel loops in the right lower chest cavity.
• Irregular right hemi-diaphragm.
• Mediastinal displacement to the left.
• Compressive atelectasis of the right upper lobe.

Overall features are suggestive of a congenital diaphragmatic hernia

In the above patient, possibilities are –

1. Bochdalek hernia – due to posterolateral defect in the diaphragm with herniation of the bowel into the hemithorax. Points against are – age of the patient, side affected (Bochdalek hernia is usually diagnosed in utero or presents soon after birth and is mostly left sided).
2. Morgagni hernia – through an anterior opening in the diaphragm (foramen of Morgagni). Mostly right sided and presents in infancy. Likely cause in the above patient but a lateral chest x-ray is needed to confirm.
3. Congenital cystic adenoid malformation – ultrasound will be useful.

Immediate management will be to pay attention to airway, breathing and circulation. Nasogastric tube insertion to help decompress the stomach to reduce splinting effect on the diaphragm. Bagging the patient to be avoided as it will further push air into the GI tract making respiratory distress worse. Early intubation if worsening respiratory distress.

Reference: https://pubs.rsna.org/doi/full/10.1148/rg.307105046