{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:53:36Z","timestamp":1777553616975,"version":"3.51.4"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:p>Congenital diaphragmatic hernia (CDH) is a rare defect that most commonly presents in neonates with severe respiratory distress. Late presentation in older children is exceedingly rare and often accompanied by nonspecific symptoms, leading to diagnostic challenges. We report the case of a 9-year-old child who initially presented with nonspecific abdominal pain, nausea, and vomiting. Initial evaluations, including computed tomography (CT) imaging, led to the initial diagnosis of a splenule. Owing to persistent symptoms, repeated imaging 2\u00a0weeks later revealed herniation of abdominal contents into the thoracic cavity, confirming a large left-sided CDH. The patient underwent thoracoscopic surgical repair of a Bochdalek defect, leading to resolution of symptoms. This case highlights diagnostic challenges surrounding late-presenting CDH, including its variable clinical presentation ranging from nonspecific gastrointestinal or respiratory symptoms, as well as challenges of radiographic interpretation. This case emphasizes the importance of considering CDH in diagnostic workups in all age groups, even when imaging findings are inconclusive, to ensure timely and accurate diagnosis and treatment.<\/jats:p>","DOI":"10.1542\/peds.2025-072739","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:02:49Z","timestamp":1767916969000},"source":"Crossref","is-referenced-by-count":2,"title":["Late-Presenting Congenital Diaphragmatic Hernia Initially Diagnosed as a Splenule on CT Imaging"],"prefix":"10.1542","volume":"157","author":[{"given":"Pinky","family":"Langat","sequence":"first","affiliation":[{"name":"1Department of Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Sun","sequence":"additional","affiliation":[{"name":"2Division of Pulmonary Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Quinn","sequence":"additional","affiliation":[{"name":"2Division of Pulmonary Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Law","sequence":"additional","affiliation":[{"name":"3Department of Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Dickie","sequence":"additional","affiliation":[{"name":"3Department of Surgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbey","family":"Winant","sequence":"additional","affiliation":[{"name":"4Department of Radiology, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Casey","sequence":"additional","affiliation":[{"name":"2Division of Pulmonary Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"issue":"11","key":"2026033105224337900_r1","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1016\/j.jpedsurg.2020.06.022","article-title":"Prevalence and risk factors for congenital diaphragmatic hernia: a global view","volume":"55","author":"Paoletti","year":"2020","journal-title":"J Pediatr Surg."},{"issue":"5","key":"2026033105224337900_r2","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1007\/s00247-004-1389-z","article-title":"Late-presenting congenital diaphragmatic hernia in children: a literature review","volume":"35","author":"Bag\u0142aj","year":"2005","journal-title":"Pediatr Radiol."},{"issue":"2\u20133","key":"2026033105224337900_r3","first-page":"93","article-title":"Herniation through the foramen of Morgagni: early diagnosis and treatment","volume":"18","author":"Al-Salem","year":"2002","journal-title":"Pediatr Surg Int."},{"issue":"12","key":"2026033105224337900_r4","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1016\/j.jpedsurg.2005.08.023","article-title":"Late-presenting congenital diaphragmatic hernia","volume":"40","author":"Kitano","year":"2005","journal-title":"J Pediatr Surg."},{"issue":"9","key":"2026033105224337900_r5","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1007\/s00383-004-1269-5","article-title":"Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum","volume":"20","author":"Bag\u0142aj","year":"2004","journal-title":"Pediatr Surg Int."},{"issue":"4","key":"2026033105224337900_r6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s10029-012-0906-5","article-title":"Late-presenting congenital diaphragmatic hernia: diagnostic pitfalls and outcome","volume":"16","author":"Baerg","year":"2012","journal-title":"Hernia."},{"issue":"1","key":"2026033105224337900_r7","doi-asserted-by":"crossref","first-page":"7518183","DOI":"10.1155\/2024\/7518183","article-title":"Beyond the neonate: a delayed presentation of congenital diaphragmatic hernia in a 17-year-old","volume":"2024","author":"Vinton","year":"2024","journal-title":"Case Rep Pediatr."},{"key":"2026033105224337900_r8","doi-asserted-by":"crossref","first-page":"bcr2012007332","DOI":"10.1136\/bcr-2012-007332","article-title":"Delayed presentation of congenital diaphragmatic hernia presenting with intrathoracic gastric volvulus: a case report and review","author":"Nayak","year":"2012","journal-title":"BMJ Case Rep."},{"issue":"12","key":"2026033105224337900_r9","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1007\/s00247-021-05131-7","article-title":"Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children","volume":"51","author":"Franke","year":"2021","journal-title":"Pediatr Radiol."},{"issue":"1","key":"2026033105224337900_r10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/1742271X15617214","article-title":"Contrast-enhanced ultrasound of the spleen","volume":"24","author":"Omar","year":"2016","journal-title":"Ultrasound."},{"issue":"3","key":"2026033105224337900_r11","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00247-011-2226-9","article-title":"Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings","volume":"42","author":"Muzzafar","year":"2012","journal-title":"Pediatr Radiol."},{"key":"2026033105224337900_r12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5402\/2011\/409252","article-title":"Late-presenting left-sided Morgagni congenital diaphragmatic hernia in a 9-year-old male","volume":"2011","author":"Kim","year":"2011","journal-title":"ISRN Pulmonol."},{"issue":"1","key":"2026033105224337900_r13","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/S1875-9572(10)60006-X","article-title":"A twenty-year review of early and late-presenting congenital Bochdalek diaphragmatic hernia: are they different clinical spectra?","volume":"51","author":"Chang","year":"2010","journal-title":"Pediatr Neonatol."},{"issue":"7","key":"2026033105224337900_r14","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1016\/j.jpedsurg.2004.03.050","article-title":"Associated malformations in delayed presentation of congenital diaphragmatic hernia","volume":"39","author":"Hosgor","year":"2004","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2026033105224337900_r15","doi-asserted-by":"crossref","first-page":"151169","DOI":"10.1053\/j.semperi.2019.07.008","article-title":"The influence of genetics in congenital diaphragmatic hernia","volume":"44","author":"Yu","year":"2020","journal-title":"Semin Perinatol."},{"issue":"1","key":"2026033105224337900_r16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/s41572-022-00362-w","article-title":"Congenital diaphragmatic hernia","volume":"8","author":"Zani","year":"2022","journal-title":"Nat Rev Dis Primers."},{"issue":"11","key":"2026033105224337900_r17","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1016\/j.ajhg.2024.08.024","article-title":"Common variants increase risk for congenital diaphragmatic hernia within the context of de novo variants","volume":"111","author":"Qiao","year":"2024","journal-title":"Am J Hum Genet."},{"issue":"6","key":"2026033105224337900_r18","doi-asserted-by":"crossref","first-page":"e230110","DOI":"10.1148\/rg.230110","article-title":"Approach to acute traumatic and nontraumatic diaphragmatic abnormalities","volume":"44","author":"Keyes","year":"2024","journal-title":"Radiographics."},{"key":"2026033105224337900_r19","doi-asserted-by":"crossref","first-page":"152269","DOI":"10.1016\/j.aanat.2024.152269","article-title":"Subdiaphragmatic phrenic nerve supply: a systematic review","volume":"254","author":"P\u00e9rez-Montalb\u00e1n","year":"2024","journal-title":"Ann Anat."},{"issue":"11S","key":"2026033105224337900_r20","doi-asserted-by":"crossref","first-page":"S329","DOI":"10.1016\/j.jacr.2022.09.016","article-title":"ACR Appropriateness Criteria\u00ae Hernia","volume":"19","author":"Garcia","year":"2022","journal-title":"J Am Coll Radiol."},{"issue":"3","key":"2026033105224337900_r21","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.ejrad.2004.09.008","article-title":"Diaphragmatic hernia: diagnostic approaches with review of the literature","volume":"54","author":"Eren","year":"2005","journal-title":"Eur J Radiol."},{"issue":"8","key":"2026033105224337900_r22","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1007\/s00247-019-04417-1","article-title":"Ultrasound evaluation of right diaphragmatic eventration and hernia","volume":"49","author":"Karmazyn","year":"2019","journal-title":"Pediatr Radiol."},{"issue":"4","key":"2026033105224337900_r23","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.jamcollsurg.2016.12.050","article-title":"Minimally invasive vs open congenital diaphragmatic hernia repair: is there a superior approach?","volume":"224","author":"Putnam","year":"2017","journal-title":"J Am Coll Surg."},{"issue":"2","key":"2026033105224337900_r24","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/MOP.0b013e3283507909","article-title":"Late onset diaphragmatic hernia complicated by intestinal strangulation","volume":"24","author":"Delaney","year":"2012","journal-title":"Curr Opin Pediatr."},{"issue":"8","key":"2026033105224337900_r25","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.21037\/tp-23-14","article-title":"Pulmonary outcomes of congenital diaphragmatic hernia patients based on defect size (CDH Study Group Stage)","volume":"12","author":"Emanuel","year":"2023","journal-title":"Transl Pediatr."},{"issue":"5","key":"2026033105224337900_r26","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.3349\/ymj.2013.54.5.1143","article-title":"Late-presenting congenital diaphragmatic hernia in children: the experience of single institution in Korea","volume":"54","author":"Kim","year":"2013","journal-title":"Yonsei Med J."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-072739\/1905518\/pediatrics.2025072739.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-072739\/1905518\/pediatrics.2025072739.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T09:22:49Z","timestamp":1774948969000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/157\/2\/e2025072739\/206064\/Late-Presenting-Congenital-Diaphragmatic-Hernia"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1,9]]},"published-print":{"date-parts":[[2026,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-072739","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"article-number":"e2025072739"}}