Waxing and Waning Congenital Diaphragmatic Hernia of Morgagni: A Diagnostic Conundrum.

A 3/2-year-old healthy girl who had swallowed a metal screw was admitted in our institution (Figure 1A). Surprisingly, the thoracoabdominal radiograph (TAR) revealed the presence of an intrathoracic herniation of intestinal loops consistent with a diaphragmatic hernia (DH). The screw was retrieved gastroscopically. Further evaluation with a barium contrast swallow study revealed normal proximal intestinal anatomy and timely contrast advancement through the duodenojejunal flexure to the terminal ileum (Figure 1B). The distal portion of the terminal ileum was anomalously located in the upper right abdominal quadrant, and the cecum and ascending colon were visualized above the diaphragm in the right hemithorax, confirming the presence of a DH (Figure 1B). Because the child was asymptomatic, elective surgery was scheduled 4 days later. Unexpectedly, a repeat preoperative TAR showed no evidence of intrathoracic