A 13 months previously healthy male child was transferred from a community emergency room for newly diagnosed congenital diaphragmatic hernia and possible emergency surgery. He had presented with two days of cough, congestion and fever. On examination, he was calm, comfortable and happy on mother's lap without any obvious respiratory distress. Respiratory auscultation had only conducted breath sounds. He had bilateral otitis media. Other systems were normal. A chest x-ray at the outside

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... y room showed loops of large bowel in the left chest cavity with some mediastinal shift. No additional studies were ordered on arrival and surgery was consulted. Patient was admitted for observation and placed on antibiotics for his otitis media. Patient was stable overnight and discharged on amoxicillin. Patient had outpatient surgery a week after hospitalization to repair his diaphragmatic hernia without any immediate complications or issues on 6 month follow-up.