Imagiological case

Abstract

Introduction: Cough is one of the main reasons to seek medical care. Although in most cases there is an underlying viral infection or allergic etiology, sometimes unexpected diagnosis arise.

Case report: We report the case of a 19 months old girl, with no prior medical history, taken to the emergency department for wet cough and rhinorrhea with no fever for the last 3 weeks. Mother reported signs of difficulty in breathing and partial food refusal. At admission she was polypneic with subcostal retraction and pulmonary auscultation revealed diminished breath sounds and prolonged expiratory time with wheezing. Blood testing was normal. Chest radiograph showed a large cystic image on the right hemithorax. Thoracic CT scan documented an intrathoracic stomach. Laparoscopy confirmed the presence of a paraesophageal hernia and Nissen fundoplication was performed. She was asymptomatic afterwards.

Discussion: Hiatus hernia is rare in paediatric age. and it was an unexpected finding in the case described. So, despite its rarity, anatomical anomalies should be considered in the differential diagnosis of persistent cough.