CHEST IMAGING: Diaphragm and Pleura
Case Author: Rachna Madan, MD, Brigham and Women’s Hospital
History
62-year-old man with lower chest and abdominal pain and a feeling of fullness.
Imaging Findings
Posteroanterior (A) and lateral (B) chest radiographs show a large mass of variable radiographic density in the right lower hemothorax and right cardiophrenic angle. In addition to soft-tissue and fat attenuation, variably sized areas of gas lucency are evident in the mass. Coronal (C and D) and sagittal (E) CT images through the chest show herniation of omental fat, mesenteric vessels, and contrast-opacified transverse colon through an anteromedial diaphragmatic defect.
- Bochdalek hernia
- Hiatal hernia
- Morgagni hernia
- Pericardial cyst
- Pericardial fat pad
Diagnosis
Morgagni hernia
Teaching Points
Morgagni hernia is a congenital hernia seen in the anterior right cardiophrenic angle region. It can be asymptomatic if small but has the potential to be a life-threatening emergency in neonates and children if large and associated with pulmonary hypoplasia. The need for surgical treatment of Morgagni hernia largely depends on the presentation. Emergency intervention is not necessary unless there are signs of strangulation.
Suggested Readings
Horton JD, Hofmann LJ, Hetz SP. Presentation and management of Morgagni hernias in adults: a review of 298 cases. Surg Endosc 2008; 22:1413–1420
Seydel B, Detry O. Morgagni’s hernia. N Engl J Med 2010; 362:e61
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