Presentation
Repeated cough and noisy breathing.
Patient Data
Well-defined, round opacity in the right cardio-phrenic angle. No obscuration of the right heart border is seen suggesting the lesion is not of pulmonary origin.
No calcifications or fat density within opacity.
There is a large defect in the right mara-midline location of the diaphragm lateral to the hiatus. Herniation of gastric cardia, fundus, and proximal body to right lower posterior mediastinum is noted through this hernia.
Mild adjacent pleural effusion is noted.
The annotated image clearly shows the defect lateral to the hiatus.
Case Discussion
The classification of the case is challenging; to call it Morgagni hernia it needs to be anterior in location. However to call it a hiatal hernia, the defect is separately seen from the course of the esophagus in the hiatus. Can it be para-esophageal hiatal hernia? If yes, then it is rare entity for the patient's age.
Unfortunately, no surgery data is available.
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