Ultrasound diagnosis of delayed-onset congenital diaphragmatic hernia associated with group B streptococcal infection

Delayed presentation of right-sided congenital diaphragmatic hernia in association with neonatal group B streptococcal pneumonia is a recently recognized entity. Its diagnosis is based on characteristic yet nonspecific chest X-ray findings, frequently supplemented by a variety of other imaging techniques. We describe two cases in which the diagnosis was reached by ultrasound examination. In the presence of nonresolving neonatal streptococcal pneumonia with the radiographic appearance of a right pleural effusion or suggestion of an elevated right hemidiaphragm, a congenital diaphragmatic hernia should be suspected. In this context, ultrasound can provide early proof of hepatic herniation before gas-containing bowel loops are seen on the cest X-ray.