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. © BMJ Publishing Group Ltd 2017. All rights reserved.

[No Keywords available]

emergency treatment differential diagnosis Diagnosis, Differential refugee rhinorrhea Hernias, Diaphragmatic, Congenital abdominal injury Hernia, Diaphragmatic diaphragm hernia viral upper respiratory tract infection heart sound thorax injury congenital diaphragm hernia Syrian Arab Republic human Refugees war priority journal emergency ward ethnology laparotomy diagnostic imaging Humans male incidental finding case report clinical evaluation preschool child Child, Preschool Down syndrome Article Syrian Syria coughing thorax radiography computer assisted tomography Italy Physical Examination Child