A case series of right-sided congenital diaphragmatic hernia with liver herniation with non-contralateral mediastinal shift: Imaging clues and the diagnostic challenge of hepatopulmonary fusion

Right-sided congenital diaphragmatic hernia (CDH) with liver herniation typically produces contralateral mediastinal shift; its absence presents a diagnostic imaging challenge and raises concern for hepatopulmonary fusion (HPF). We report three infants with right-sided CDH and liver herniation without contralateral shift, including two cases of HPF and one non-HPF case attributable to severe pulmonary hypoplasia. This series demonstrates that non-contralateral or ipsilateral mediastinal shift, although classically associated with HPF, is not pathognomonic. We highlight the complementary roles and limitations of radiography, ultrasonography, and contrast-enhanced CT in suggesting HPF preoperatively. These cases refine radiologic clues for this rare presentation and underscore the importance of meticulous multimodality imaging to inform surgical planning and anticipate operative complexity.