Congenital diaphragmatic hernia (CDH) is an uncommon neonatal pediatric surgical problem. About 5-25% of cases had delayed presentation, making diagnostic challenge and requiring a high index of suspicion. Combination of diaphragmatic hernia and severe pneumonia with rapid deterioration of the case up to respiratory failure is a rare occasion. Herein, we present a case of 2-years-old female referred to our hospital intubated, ventilated due to type 2 respiratory failure resulting from dual chest pathology (severe pneumonia and left sided congenital diaphragmatic hernia). She was admitted at the pediatric intensive care unit (PICU), stabilized then operated for repair of her diaphragmatic hernia. Post-operatively, she remained intubated, ventilated for 7 days then weaned gradually from the ventilator. The cardiorespiratory status has much improved and she started oral feeding by the 8th post-operative day and discharged home in a stable condition.