Delayed appearance of right diaphragmatic hernia associated with group B streptococcal infection in newborns

Right diaphragmatic hernia should be considered when an infant with Group B streptococcal infection shows deterioration. Although the diaphragm appears normal at first, increased density is seen in the right lower lobe shortly thereafter, indicating pneumonia and/or irregular aeration. Pleural effusion may develop over the next few days. Characteristically, the bowel gas on the right and the liver shadow gradually become elevated and the heart and mediastinal structures shift into the left hemithorax; loops of bowel may be seen in the right hemithorax as well. Static plain views should confirm hernia or eventration, necessitating immediate surgery.