LAUSR

A 1-month-old boy presented at the paediatric emergency department (PED) with a history of 1 day of persistent vomiting with no fever or diarrhoea in previous days. Prenatal and postnatal history was unremarkable. On initial examination, appearance was altered in the Paediatric Assessment Triangle. Vital signs were: heart rate of 150 beats per minute, respiratory rate 50 breaths per minute, basal oxygen saturation 98% and capillary blood glucose of 110 mg/dL, and he was afebrile. Lung examination was normal and the abdomen was soft, non-tender and non-distended. He was reactive but listless, anterior fontanel was normal. Blood and urine test results obtained were normal. During the observation period, he had no vomiting. However, he developed sudden onset respiratory distress with moderate subcostal, intercostal and suprasternal retractions. Air entry was reduced on the left hemithorax. A point-of-care lung ultrasound (POCUS) was performed using a Mindray DC-40 (Shenzhen, China) sonographer by an emergency medicine paediatrician with POCUS training. A highfrequency linear transducer(6–14 MHz) was employed. POCUS revealed intestinal loops in all intercostal spaces of the left hemithorax, confirming the diagnosis of congenital diaphragmatic hernia (CDH) (Fig. 1, Video S1, Supporting Information). Chest and abdominal radiography was obtained (Fig. 2). Given these findings, the patient was evaluated by a paediatric surgeon and was admitted for surgical intervention. The surgery was successful, and the patient completely recovered.