An infant with hyperechoic cystic kidneys and congenital diaphragmatic hernia: Questions

Excerpt

A 2-month-old female presented to the emergency department with increased work of breathing not associated with fever, nasal congestion, or rhinorrhea. Vital signs were remarkable for elevated heart and respiratory rates. Her oxygen saturation was normal on room air. Physical examination showed nasal flaring and chest retraction. Mild facial dysmorphic features, including bitemporal narrowing, frontal bossing, and a broad nasal bridge, were noted. A chest X-ray was remarkable for left hemidiaphragm elevation, normal cardiac silhouette, and no focal pulmonary consolidation, pleural effusion, or pneumothorax. A nasopharyngeal swab PCR was positive for rhinovirus infection. She was admitted to the general pediatric hospitalist service for respiratory distress, in the setting of presumed bronchiolitis. Over time, she required more oxygen support. A CT chest was obtained to further evaluate her elevated left hemidiaphragm and revealed findings of congenital diaphragmatic hernia. …