Tension gastrothorax in a late-presenting congenital diaphragmatic hernia: a case report and review of the literature.

Congenital diaphragmatic hernia (CDH), a rare but potentially life-threatening anomaly resulting from incomplete diaphragm closure during fetal development, typically presents neonatally but can rarely manifest later in infancy as tension gastrothorax-a critical condition of intrathoracic gastric herniation and distension causing severe respiratory distress and mediastinal shift; we describe a 2-month-old male infant who developed sudden dyspnea and mediastinal shift due to a left-sided Bochdalek hernia with a distended stomach occupying the thoracic cavity, requiring emergent laparotomy with gastric decompression and defect repair using non-absorbable sutures, leading to full lung re-expansion and recovery; this case highlights the diagnostic and therapeutic challenges of late-presenting CDH complicated by tension gastrothorax, the importance of distinguishing it from other causes of respiratory distress, and emphasizes that prompt recognition, timely decompression, and surgical repair are vital for favorable outcomes, urging clinicians to maintain high suspicion when imaging reveals an air-filled hemithorax in distressed infants.