A 4-year-old boy from Syria was evaluated at the emergency department because of an upper airway viral illness. His physical examination showed a significant intensity reduction of all heart sounds in the absence of any other pathological signs. As the child was affected with Down's syndrome and had suffered thoracic and abdominal trauma because of bombardments, a diaphragmatic hernia was immediately suspected and was confirmed through a simple chest X-ray. A careful clinical examination is crucial in refugee children and adolescents, as several medical and surgical disorders could have escaped previously.
- emergency medicine
- paediatric surgery
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Contributors DP conceived and wrote the manuscript; TB contributed to review the medical literature; SS and GLM provided intellectual contribution.
Competing interests None declared.
Patient consent Consent obtained from Guardian.
Provenance and peer review Not commissioned; externally peer reviewed.
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